Love Conquers all but Nicotine: Spousal Peer Effects on the Decision to Quit Smoking

If two partners smoke, their quit behavior may be related through correlation in unobserved individual characteristics and through common shocks. However, there may also be a causal effect whereby the quit behavior of one partner is affected by the quit decision of the other partner. If so, there is a spousal peer effect on the decision to quit smoking. We use data containing retrospective information of Dutch partnered individuals about their age of onset of smoking and their age of quitting smoking. We estimate mixed proportional hazard models of starting rates and quit rates of smoking in which we allow unobserved heterogeneity to be correlated across partners. Using a timing of events approach, we determine whether the quitting‐to‐smoke decision of one partner has a causal effect on the quitting‐to‐smoke decision of the other partner. We find no evidence of substantial spousal peer effects in the decision to quit smoking. Apparently, love conquers all but nicotine addiction. Copyright © 2017 John Wiley & Sons, Ltd.     

Smoking among low-income pregnant women: an ethnographic analysis.

This article presents findings from a qualitative study of 53 low-income women who were smokers at the onset of pregnancy. Study participants were interviewed during pregnancy to document smoking trajectories and factors contributing to, or undermining, harm reduction and quit attempts. Thirty percent of women quit smoking completely, 43% engaged in sustained harm reduction, and 26% reduced their smoking levels intermittently. Case studies of women are presented to illustrate reasons for quitting, harm reduction practices, and factors influencing relapse and smoking continuation. Women's motivations to quit are highlighted. Moral identity as a mother was found to be a key motivating factor behind women's quit attempts. Future programs targeting this population would do well to acknowledge moral identity as an issue and recognize the challenges of quitting for women with limited social support and little control over their immediate environment.     

Can decision analysis adequately represent clinical problems?

A major weakness of medical decision analysis has been the inability of the commonly used single attribute utility models to adequately represent clinical decision making situations. To illustrate this problem, I reanalyzed a well known decision analysis that is widely interpreted as proof that two decision alternatives are equivalent in all clinically meaningful respects. The reanalysis was based on a more representative decision model made possible by the use of the analytic hierarchy process (AHP), a multiobjective decision making technique. The use of this model resulted in the identification of a clearly preferred alternative, indicating that the results of the original analysis have been widely misinterpreted. The degree to which a decision model represents clinical reality influences the correct interpretation of a decision analysis. Limited decision models can yield only limited conclusions. The use of more representative multiobjective decision models would improve the clinical usefulness of medical decision analyses.     

Self-control and support for anti-smoking policies among smokers, ex smokers, and never smokers

In this paper, we sustain that non-smokers who might be at risk of starting to smoke or relapsing can benefit from anti-smoking policies such as tax hikes and smoking bans because these are mechanisms that enhance their self-control with regard to tobacco consumption. We formalize this conjecture by proposing a model where starting/relapsing might result from time inconsistent preferences in a way that mirrors the inability of some smokers to carry out the decision to quit. Subsequently, we specify econometric models that allow us to test the implications of such conjecture using information on smoking behavior at the individual level from the Catalan Health Survey of 2006. The empirical results support our conjecture and suggest that the welfare gains derived from the reinforcement of self-control caused by tax hikes and smoking bans will accrue not only to smokers but also to the rest of the population.     

Examination of the use of smoking for weight control in restrained and unrestrained eaters

Recent research has examined the perceived benefits of smoking and suggests that continued smoking may be related to contemporary concerns for weight and shape. The present study examined the role of restrained eating in predicting smoking for reasons of weight control, reports of weight gain following cessation, and reasons for relapse and intentions to quit. Eighty-four restrained eaters and 83 unrestrained eaters completed a questionnaire examining their smoking behavior. The results suggest that the restrained eaters gave significantly greater endorsement than the unrestrained eaters to statements relating to smoking initiation and smoking maintenance for weight control, the role of weight gain in previous experiences of smoking relapse, intentions to quit following weight loss, and intentions to quit in 5 years. No differences were found between the restrained and unrestrained eaters in terms of experiences of post cessation weight gain, the number of attempts to quit, and intentions to quit in 6 months. The results are discussed in terms of developing a model of the relationship between smoking and weight concerns. © 1994 by John Wiley & Sons, Inc.     

Modeling the future effects of a menthol ban on smoking prevalence and smoking-attributable deaths in the United States

We used a validated smoking simulation model and data from the 2003 Tobacco Use Supplement to the Current Population Survey to project the impact that a US menthol ban would have on smoking prevalence and smoking-attributable deaths. In a scenario in which 30% of menthol smokers quit and 30% of those who would have initiated as menthol smokers do not initiate, by 2050 the relative reduction in smoking prevalence would be 9.7% overall and 24.8% for Blacks; deaths averted would be 633,252 overall and 237,317 for Blacks.     

Dependency, social factors, and the smoking cessation process: the doctors helping smokers study

We analyzed data obtained from a representative sample of the smoking patients (n = 1,338) of 66 family physicians to determine predictors of attempts to stop smoking, desire to quit smoking, and successful smoking cessation. Compared to subjects who made no attempt to quit smoking, subjects who tried to quit smoking tended to be younger, had tried to quit smoking in the year prior to the study, waited longer before smoking their first cigarette of the day, had more desire to quit smoking, and had more social support for quitting. Education and cigarettes smoked per day were not independently related to the subject making a quit attempt. Desire to quit smoking was associated with an attempt to quit in the year prior to the study and social support for smoking cessation (support of spouse, second most important social contact, and physician). Desire to quit smoking was not independently related to age, education, or dependency on cigarettes (measured by the number of cigarettes smoked per day and the length of time a subject waited before smoking the first cigarette of the day). Compared to subjects who tried to quit and failed, subjects who succeeded were older, smoked fewer cigarettes per day, and waited longer to smoke their first cigarette of the day. Spouse support, support of the second most important social contact, and advice of a doctor to quit smoking were not independently related to whether or not a cessation attempt would be successful. These data suggest that successful smoking cessation requires two components: social support to make an attempt to quit and the ability to overcome dependency on cigarettes to make the attempt successful.     

Perceptions of health risk and smoking decisions of young people

Using the Annenberg Perception of Tobacco Risk Survey 2, this paper finds that perceived risk deters smoking among persons aged 14-22 years who think that it is relatively difficult to quit smoking and that onset of deleterious health effects occurs relatively quickly. Perceived health risk, however, does not affect the smoking status of young people who hold the opposite beliefs. These results are consistent with predictions of rational addiction models and suggest that young people, who view smoking as more addictive and health effects as more immediate, may have greater incentive to consider long-term health effects in their decision to smoke.     

Smoking: attitudes of Costa Rican physicians and opportunities for intervention.

The aim of this study was to obtain information, using a written questionnaire, on the knowledge, smoking behaviour, and attitudes of Costa Rican physicians about smoking as a health issue. A random sample of 650 physicians was chosen from a list of active physicians; 287 of them were covered by survey between August 1993 and October 1994, and 217 (76%) responded with data for the study. While 40% of the physicians who participated were ex-smokers, 19% were current smokers; 67% of these two groups combined reported smoking in the workplace. Only 49% believed that physicians could be a nonsmoking role model; the majority (87%) had asked patients about their smoking status. The only cessation technique consistently used (90%) was counselling about the dangers of smoking. Measures such as setting a date to quit smoking and nicotine replacement were rarely recommended (< or = 2%). Nearly all the physicians (99%) considered smoking to be a major health issue. These results showed a high prevalence of smoking among Costa Rican physicians, with little recognition of the need for them to set an example as a role model. While they were knowledgeable about the health risks of smoking, they did not recommend any of the proven techniques to help their patients to quit smoking. A clear consensus for more strict tobacco regulation exists, but to date little has been done to act on this.     

Analysis of willingness-to-quit cigarette price among Korean male adults]

OBJECTIVES: The purpose of this study was to estimate the willingness to quit cigarette price among Korean male adults, and to examine he factors affecting the willingness to quit cigarette price. METHODS: The data was collected by a random digit dial telephone survey. 702 samples were analyzed by using t-tests, ANOVA and OLS regression analysis. To estimate the willingness to quit cigarette price, smokers were asked dichotomous questions with open-ended follow-up and the starting point of the price was randomized by one of 5 bid prices elicited from a pilot study. RESULTS: The mean of the willingness to quit cigarette price was 4,287 Won per package, which was about 2,000 Won higher than the mean of the actual price the smokers now paid. About 41% of respondents were willing to quit smoking if the price of cigarette would be increased by 3,000 Won, and if the price would be increased by 20,000 Won, all respondents were willing to quit smoking. The factors associated with the willingness to quit cigarette price were the place of residence, the amount of smoking and the degree of exposure to smoking through the mass media. CONCLUSIONS: The results showed that to get people to quit smoking, increasing the cigarette price would obviously be effective and much higher prices have a greater effect. Furthermore, to enlarge the effect of increased cigarette prices, providing more cessation programs to small towns, reducing the amount of smoking and decreasing or prohibiting advertisements of cigarettes and smoking in the mass media will be efficient.     

The effect of cigarette price on smoking behavior in Korea]

OBJECTIVES: To determine the impact of cigarette prices on the decision to initiate and quit smoking by taking into account the interdependence of smoking and other behavioral risk factors. METHODS: The study population consisted of 3,000 male Koreans aged > or =20. A survey by telephone interview was undertaken to collect information on cigarette price, smoking and other behavioral risk factors. A two-part model was used to examine separately the effect of price on the decision to be a smoker, and on the amount of cigarettes smoked. RESULTS: The overall price elasticity of cigarettes was estimated at -0.66, with a price elasticity of -0.02 for smoking participation and -0.64 for the amount of cigarettes consumed by smokers. The inclusion of other behavioral risk factors reduced the estimated price elasticity for smoking participation substantially, but had no effect on the conditional price elasticity for the quantity of cigarettes smoked. CONCLUSIONS: From the public health and financial perspectives, an increase in cigarette price would significantly reduce smoking prevalence as well as cigarette consumption by smokers in Korea.     

Health, addiction, social interaction and the decision to quit smoking

The decision to quit smoking is treated as a choice under uncertainty in an empirical model that incorporates health, medical advice, addiction, and social interaction. Probit models are estimated for attempts and success in quitting with data from the Health and Lifestyle Survey. The results show a clear role for addiction, social interaction and current health status. The evidence on the effectiveness of medical advice is ambiguous.     

Estimation of the break-even point for smoking cessation programs in pregnancy.

BACKGROUND. Successful programs to help pregnant women quit smoking have been developed and evaluated, but formal smoking cessation programs are not a part of care at most prenatal sites. The cost of such programs may be an issue. Considering the costs of adverse maternal and infant outcomes resulting from smoking, we estimated there would be an amount of money a prenatal program could invest in smoking cessation and still "break even" economically. METHODS. A model was developed and published data, along with 1989 hospital charge data, were used to arrive at a break-even point for smoking cessation programs in pregnancy. RESULTS. Using overall United States data, we arrived at a break-even cost of $32 per pregnant woman. When these data were varied to fit specific US populations, the break-even costs varied from $10 to $237, with the incidence of preterm low birth weight having the most impact on the cost. CONCLUSIONS. It may be advisable to invest greater amounts of money in a prenatal smoking cessation program for some populations. However, for every population there is an amount that can be invested while still breaking even.     

A simulation model of policies directed at treating tobacco use and dependence.

OBJECTIVES: The authors develop a simulation model to predict the effects on quit rates and cost-effectiveness of different smoking treatment policies. METHODS: A decision theoretic model of quit behavior is first developed that incorporates the decision to quit and the choice of treatment. A policy model then examines the effect on quit attempts and quit rates of policies to cover the costs of different combinations of treatments and to require health care providers to conduct brief interventions. The model incorporates substitution between treatments and effects of policies on treatment effectiveness. The cost per quit is also calculated for each policy. RESULTS: The model of quit behavior predicts a 1-year quit rate of 4.5% for the population of smokers. The policy model predicts a 37% increase in quit rates from a policy that combines mandated brief interventions with coverage of all proven tobacco treatments. Smaller effects are predicted from policies that provide more restricted coverage of treatments, especially those limited to behavioral treatment. Payments for brief interventions alone increase quit rates by about 7%. Brief intervention and behavioral therapy policies had lower costs per quit but yield substantially fewer additional quits than policies that cover pharmacotherapy. There is, however, considerable variation around these estimates depending on assumptions about the effects of policy on treatment use, substitution between treatments, and treatment effectiveness. CONCLUSION: Tobacco treatment policies, especially those with broad and flexible coverage, have the potential to substantially increase smoking quit rates. However, further research is needed on the effect of payment policies on the use and effectiveness of tobacco treatments.     

Social support in smoking cessation among black women in Chicago public housing.

To accomplish significant reductions in smoking by the year 2000, special populations with relatively low rates of smoking cessation must be reached and helped to quit smoking. These populations are most often groups in which traditional approaches to smoking cessation have not been successful. Focus groups were conducted with black women who were residents of Chicago public housing developments. The purposes were to assess factors related to smoking and the women''s willingness to participate in cessation programs. The findings reveal several barriers to smoking cessation. These barriers are linked to the difficult daily existence and environment of these women and to a lack of social support that would help them to achieve smoking cessation. The barriers include (a) managing their lives in highly stressful environments, (b) major isolation within these environments, (c) smoking as a pleasure attainable with very limited financial resources, (d) perceived minimal health risks of smoking, (e) commonality of smoking in their communities, (f) scarcity of information about the process of cessation available to them, and (g) belief that all they need is the determination to quit on their own. The women emphasized that smoking cessation would be more relevant to them if part of broader social support efforts geared to improve their lives. The public health system may need to consider such strategies to engage this group of women.     

The cost-effectiveness of three smoking cessation programs

This study analyzed the cost-effectiveness and distribution of costs by program stage of three smoking cessation programs: a smoking cessation class; an incentive-based quit smoking contest; and a self-help quit smoking kit. The self-help program had the lowest total cost, lowest per cent quit rate, lowest time requirement for participants, and was the most cost-effective. The most effective program, the smoking cessation class, required the most time from participants, had the highest total cost, and was the least cost-effective. The smoking contest was in-between the other two programs in total costs, per cent quit rate, and cost-effectiveness; it required the same time commitment from participants as the self-help program. These findings are interpreted within the context of community-based intervention in which the argument is made that cost-effectiveness is only one of several factors that should determine the selection of smoking cessation programs.     

Multivariate prediction of smoking cessation following physician advice to quit smoking: A validation study

A multivariate predictive model was developed to classify patients with respiratory disease as to their smoking status following physician advice to quit (L. L. Pederson, J. C. Baskerville, and J. M. Wanklin, Prev. Med.11, 536–549 (1982)). The purpose of this study was to validate this model on a new group of patients by comparing their predicted smoking behavior with their actual behavior. Using a probability of 0.50 as the cutoff for prediction, overall accuracy was 89.6%. However, the sensitivity for detecting those who would actually quit was low. By reducing the cutoff probability to 0.20, overall accuracy remained high and sensitivity was increased. A discussion of the implications of different types of classification errors is presented based on cost-effectiveness considerations. The clinical usefulness of prediction models is discussed.     

It is possible to help smokers in early motivational stages to quit. The Inter99 study

BACKGROUND: In a population-based sample of smokers in early motivational stages, we found a high acceptance of smoking cessation groups. METHODS: Inter99 is a randomized population-based intervention study, in Copenhagen, Denmark. Smokers in all motivational stages were included. All participants underwent a lifestyle consultation and 2,168 smokers in the high intensity intervention group were offered assistance to quit in smoking cessation groups. RESULTS: Thirty-five percent were validated to be continuously abstinent at the end of the smoking cessation groups. Eighty-four percent of the smokers achieving sustained abstinence in our study had no serious plans to quit soon before the lifestyle consultation. Motivation to quit before the lifestyle consultation could not predict abstinence. Being a man, and having a job and at least 1 year of vocational training were predictors of abstinence in a multivariate model, whereas high nicotine dependence and living with a smoking spouse were predictors of failure. CONCLUSION: High cessation rates were obtained in a population of heavy smokers with moderate nicotine dependence. It was possible to obtain sustained abstinence in smokers in early motivational stages. These smokers would probably not have been reached by traditional smoking campaigns.     

Modeling heaping in self-reported cigarette counts

In studies of smoking behavior, some subjects report exact cigarette counts, whereas others report rounded-off counts, particularly multiples of 20, 10 or 5. This form of data reporting error, known as heaping, can bias the estimation of parameters of interest such as mean cigarette consumption. We present a model to describe heaped count data from a randomized trial of bupropion treatment for smoking cessation. The model posits that the reported cigarette count is a deterministic function of an underlying precise cigarette count variable and a heaping behavior variable, both of which are at best partially observed. To account for an excess of zeros, as would likely occur in a smoking cessation study where some subjects successfully quit, we model the underlying count variable with zero-inflated count distributions. We study the sensitivity of the inference on smoking cessation by fitting various models that either do or do not account for heaping and zero inflation, comparing the models by means of Bayes factors. Our results suggest that sufficiently rich models for both the underlying distribution and the heaping behavior are indispensable to obtaining a good fit with heaped smoking data. The analyses moreover reveal that bupropion has a significant effect on the fraction abstinent, but not on mean cigarette consumption among the non-abstinent.