A comparison of younger-aged and older-aged women in a behavioral self-control smoking program

This study examines differences in motivation for quitting smoking, withdrawal experiences and weight changes in younger and older aged women who entered a smoking cessation program designed specifically for women smokers. In an assessment prior to quitting smoking 26 women aged 20-49 years (younger-aged women) and 19 women aged 50-75 years (older-aged women) did not show differences in number of prior quit attempts or their dependence on nicotine (as measured in the Fagerstrom Tolerance Questionnaire). The older aged women smoked for a significantly greater number of years but smoked fewer cigarettes per day than the younger women. In a self-report questionnaire the two age groups differed in their reasons stated for wanting to give up cigarettes and symptoms of illness they experienced related to smoking. The average weight gains for women who quit smoking were minimal (3.5 lb, younger; 3.9 lb, older; 1 lb = 0.453 592/37 kg) although more younger women than older women reported they expected difficulty with weight gain after cessation. Changes in withdrawal experiences were not significantly different at any point during the initial phase of quitting (24, 48 and 72 h).     

Smoking cessation and severity of weight gain in a national cohort

BACKGROUND. Many believe that the prospect of weight gain discourages smokers from quitting. Accurate estimates of the weight gain related to the cessation of smoking in the general population are not available, however. METHODS. We related changes in body weight to changes in smoking status in adults 25 to 74 years of age who were weighed in the First National Health and Nutrition Examination Survey (NHANES I, 1971 to 1975) and then weighed a second time in the NHANES I Epidemiologic Follow-up Study (1982 to 1984). The cohort included continuing smokers (748 men and 1137 women) and those who had quit smoking for a year or more (409 men and 359 women). RESULTS. The mean weight gain attributable to the cessation of smoking, as adjusted for age, race, level of education, alcohol use, illnesses related to change in weight, base-line weight, and physical activity, was 2.8 kg in men and 3.8 kg in women. Major weight gain (greater than 13 kg) occurred in 9.8 percent of the men and 13.4 percent of the women who quit smoking. The relative risk of major weight gain in those who quit smoking (as compared with those who continued to smoke) was 8.1 (95 percent confidence interval, 4.4 to 14.9) in men and 5.8 (95 percent confidence interval, 3.7 to 9.1) in women, and it remained high regardless of the duration of cessation. For both sexes, blacks, people under the age of 55, and people who smoked 15 cigarettes or more per day were at higher risk of major weight gain after quitting smoking. Although at base line the smokers weighed less than those who had never smoked, they weighed nearly the same at follow-up. CONCLUSIONS. Major weight gain is strongly related to smoking cessation, but it occurs in only a minority of those who stop smoking. Weight gain is not likely to negate the health benefits of smoking cessation, but its cosmetic effects may interfere with attempts to quit. Effective methods of weight control are therefore needed for smokers trying to quit.     

Cigarette smoking and attitudes toward quitting among black patients

A sample of 1,388 black patients attending the medical clinic of a general public hospital were interviewed regarding smoking habits and attitudes toward quitting. Current smokers constituted 30% of respondents of both sexes, and approximately half of the sample were ex-smokers. Rates of current smoking were lower, and cessation rates higher, among older individuals and men. Two thirds of current smokers expressed a desire to quit, and of those an equal proportion wanted to participate in a formal cessation program. A majority of smokers reported attempting to quit on their own, and most had made more than one attempt. Given the large burden from cigarette-related disease in the black population, and the current absence of effective primary prevention efforts, smoking intervention in the clinical setting will remain an important obligation of health providers caring for black patients. This article demonstrates moderately high smoking prevalence rates of black individuals already under care for chronic illness, and a concomitant high level of desire to quit. The absence of effective programs appears to be the obstacle preventing significant progress in this important area of health promotion.     

Learned resourcefulness and smoking cessation revisited

OBJECTIVE: Even though many young addicted smokers profess a desire to quit, majority of them are unsuccessful in their attempts. A major goal was to determine whether successful quitters are better equipped cognitively and behaviorally to deal with the adverse effects associated with the cessation process than unsuccessful quitters, because they possess a larger repertoire of learned resourcefulness skills. METHOD: Undergraduate university students, consisting of 69 never-smokers, 59 successful quitters and 61 unsuccessful quitters, completed Rosenbaum's (1980) Self-Control Schedule assessing one's general repertoire of learned resourcefulness skills. Daily smoking rate, age started smoking, years smoking, quit attempts, difficulty quitting, quitting importance, motivation, self-efficacy and use of smoking self-regulatory strategies also were compared for the smoking groups. RESULTS: Never-smokers and successful quitters were significantly more resourceful than unsuccessful quitters. Even though both smoking groups smoked the same daily rate and started smoking at the same age, unsuccessful quitters in comparison to successful quitters viewed quitting smoking as less important and as more difficult, were more extrinsically motivated to quit, less efficacious, and used fewer self-regulatory strategies during their quit attempts. DISCUSSION: The discussion highlights the prominent role that SCS scores, self-efficacy and especially perceived quitting difficulty play in the smoking cessation process. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Low resourceful smokers having difficulty quitting may find workshops on general life skills beneficial. Concurrently providing them with specific smoking cessation strategies may further serve to enhance these smokers' self-efficacy.     

Perceived barriers to and benefits of attending a stop smoking course during pregnancy

OBJECTIVE: During pregnancy, the uptake of smoking cessation courses is very low. We assessed perceived barriers to and benefits of attending a cessation course during pregnancy. METHODS: A decisional-balance questionnaire was devised, including 10 statements reflecting benefits of attending a cessation course and 10 statements of barriers to attendance. The questionnaire was delivered via the Internet and targeted pregnant smokers/recent ex-smokers. Participants completed the questionnaire on a single occasion, indicating their agreement with each statement. RESULTS: Among 443 respondents, the most frequently endorsed barriers were 'Being afraid of disappointing myself if I failed' (54%) and not tending to seek help for this sort of thing (41%). The most frequently endorsed benefits were advice about cigarette cravings (74%) and praise and encouragement with quitting (71%). A greater interest in receiving help with quitting from a counselor was significantly associated with: being older, lower income, husband/partner advising cessation and less confidence in quitting. CONCLUSION: Pregnant smokers perceive many benefits of smoking cessation courses. However, these women also perceive many barriers to attendance and studies are needed to evaluate interventions for overcoming such barriers. PRACTICE IMPLICATIONS: Smoking cessation services need to address the perceived barriers to attending stop smoking courses during pregnancy, to publicise the benefits of these courses and to target women who feel that they cannot quit without this type of support.     

Characteristics of patients with COPD in three motivational stages related to smoking cessation

OBJECTIVE: To characterize patients with chronic obstructive pulmonary disease (COPD) in different motivational stages related to smoking cessation. METHODS: 633 smoking COPD patients from 67 general practices participated in a cross-sectional study. The patients were compared with respect to health indicators, demographics, self-efficacy, nicotine dependence, attitudes, and action plans. RESULTS: In line with previous Dutch results, smokers in precontemplation associated significantly fewer advantages with smoking cessation than smokers contemplating quitting and preparing to quit. Preparers had significantly higher self-efficacy expectations about quitting than the other smokers. Patients preparing to quit suffered from more COPD complaints than precontemplators. Smokers contemplating quitting and preparing to quit developed more plans to turn intentions to quit into action. CONCLUSION: More than 50% of the smokers with COPD are amenable to smoking cessation support. Preparers and contemplators did not differ as much as previous studies found. It would be advantageous to tailor COPD counseling to two distinct groups (unmotivated smokers and smokers motivated to quit), to discuss the advantages of quitting with unmotivated smokers, and to increase self-efficacy, and action planning for smokers motivated to quit. PRACTICE IMPLICATIONS: COPD patients are amenable to counseling to quit smoking. Addressing COPD complaints may contribute to greater motivation.     

Self-help quit smoking interventions: effects of self-help materials, social support instructions, and telephone counseling

Smokers requesting self-help materials for smoking cessation (N = 2,021) were randomized to receive (a) an experimental self-quitting guide emphasizing nicotine fading and other nonaversive behavioral strategies, (b) the same self-quitting guide with a support guide for the quitter's family and friends, (c) self-quitting and support guides along with four brief counselor calls, or (d) a control guide providing motivational and quit tips and referral to locally available guides and programs. Subjects were predominantly moderate to heavy smokers with a history of multiple previous quit attempts and treatments. Control subjects achieved quit rates similar to those of smokers using the experimental quitting guide, with fewer behavioral prequitting strategies and more outside treatments. Social support guides had no effect on perceived support for quitting or on 8- and 16-month quit rates. Telephone counseling increased adherence to the quitting protocol and quit rates.     

Locus of control and success in self-initiated attempts to stop smoking

Investigated the relationship between self-control behavior and individual differences on Rotter's I-E scale. Ss (N = 42) who were successful in self-initiated attempts to stop smoking showed a more internal locus of control than Ss who were either unsuccessful in their attempts to quit or who never attempted to quit smoking on their own. Further, it was found that Ss who succeeded in quitting were more likely to use abrupt smoking cessation techniques than those who failed in their attempts to quit smoking. The results of this study point out the importance of the locus of control orientation in designing self-control programs for the modification of smoking behavior.     

African-American menthol and nonmenthol smokers: differences in smoking and cessation experiences

BACKGROUND: Despite smoking fewer cigarettes per day, African Americans have lower cessation rates and experience disproportionately higher rates of smoking-related health consequences. Because of their high preference for menthol cigarettes, it has been suggested that smoking menthol cigarettes may contribute to the excess smoking-related morbidity experienced by African Americans. Smoking menthol cigarettes could increase health risks from smoking if smokers of menthol cigarettes have lower cessation rates and thereby have longer duration of smoking compared to smokers of nonmentholated cigarettes. Few studies have examined associations between smoking of mentholated cigarettes and smoking cessation among African Americans. This study examined the smoking patterns of menthol cigarette smokers and their smoking cessation experiences. METHODS: A cross-sectional survey of 480 African-American smokers at an inner-city health center. Survey examined sociodemographics, smoking characteristics, and smoking cessation experiences of participants. Menthol smokers (n = 407) were compared to nonmenthol smokers (n = 73) in these characteristics. RESULTS: Menthol smokers were younger and more likely to smoke cigarettes with longer rod length, with filters, and those high in nicotine and tar. Although both groups did not differ by number of past quit attempts, time since most recent quit attempt was shorter for menthol smokers. The durations of most recent and longest-ever quit attempts were nonsignificantly shorter for menthol, compared to nonmenthol smokers. CONCLUSIONS: These data suggest that African-American menthol smokers are less successful with smoking cessation. Prospective studies are needed to confirm these findings and examine mechanisms underlying such differences.     

Smoking-Specific Experiential Avoidance is Indirectly Associated with Trait Worry and Smoking Processes among Treatment-Seeking Smokers

Limited work has examined worry, or apprehensive anticipation about future negative events, in terms of smoking. One potential explanatory factor is the tendency to respond inflexibly and with avoidance in the presence of smoking-related distress (smoking-specific experiential avoidance). Participants (n = 465) were treatment-seeking daily smokers. Cross-sectional (pre-treatment) self-report data were utilized to assess trait worry, smoking-specific experiential avoidance, and four smoking criterion variables: nicotine dependence, motivational aspects of quitting, perceived barriers to smoking cessation, and severity of problematic symptoms reported in past quit attempts. Trait worry was significantly associated with greater levels of nicotine dependence, motivation to quit smoking, perceived barriers for smoking cessation, and more severe problems while quitting in the past; associations occurred indirectly through higher levels of smoking-specific experiential avoidance. Findings provide initial support for the potential role of smoking-specific experiential avoidance in explaining the association between trait worry and a variety of smoking processes.     

Smoking risk and the likelihood of quitting among African-American female light and heavy smokers

While African-American females are more likely to be light smokers compared to their counterparts of other racially classified social groups (RCSGs), they are more likely to carry a heavier burden of smoking-related morbidity and mortality. Thus, it is critical that African-American female light smokers are targeted to engage in smoking cessation. Research has revealed that African-American women are less likely to have a successful quit attempt following a cessation intervention than females from other RCSGs. It has been postulated that the low smoking cessation rates among African-American female light smokers may be due to the lack of appropriate psychosocioculturally tailored cessation interventions that address issues of stress and coping that explain why they smoke and continue to smoke that may differ from their heavy smoker counterparts. The purpose of this study was to ascertain whether African-American female light smokers differed from their heavy smoker counterparts on psychosociocultural stress and coping factors. Findings revealed no differences in the sociodemographic variables of age, income, education and BMI; in the psychosociocultural measures of acculturative stress, race-related stress and coping; or in the smoking characteristics of menthol smoking status, cotinine level and CYP2A6 metabolic functioning between light and heavy smokers. However, the study found that African-American female light smokers take longer to smoke their first cigarette of the day, have a lower smoking risk, are more likely to quit, and exhibit lower carbon monoxide levels than African-American female heavy smokers. The current study suggests that other than the obvious factors of greater likelihood of quitting, lower smoking risk, longer latency to smoke and lower carbon monoxide levels, specific smoking cessation programs may not need to be differentially psychosocio-culturally tailored for African-American female light smokers compared to their heavy-smoking counterparts.     

Prospects for smoking cessation among people with insulin-dependent diabetes

As part of an initiative to develop a smoking cessation resource tailored to the needs of smokers with diabetes, we undertook a survey of 223 people with insulin-dependent diabetes (IDDM) aged 15–40 years, 54 of whom were smokers. Smokers had high levels of awareness that smoking increases the risk of heart and peripheral vascular disease, but were less aware of the risk of microvascular complications. Nearly half of the smokers had other members of the household who were smokers, and 56% indicated they would expect to receive no more than a little encouragement from friends and family members to quit. Concern about weight gain and dietary adherence was a barrier to quitting smoking for approximately one-third of smokers. Seventy percent of smokers recalled advice to quit smoking from a general practitioner, but this most often had involved minimal advice to quit. There is scope for patient education with respect to microvascular complications exacerbated by smoking, and a need to consider the smoking habits of other household members and enlist their active support for smoking cessation.     

Cigarette smoking and the intention to quit among pregnant smokers

Research has demonstrated that smoking during pregnancy has deleterious effects on the health of the unborn child as well as the mother. The present study examined whether pregnant smokers would have a greater intention to quit smoking, whether the stage of pregnancy would influence the intention to quit, and whether variables which have predicted cessation among pregnant smokers would also predict intention to quit. The results indicated that pregnant women did not have a significantly greater intention to quit smoking compared to nonpregnant smokers, despite the health risks to their child. Women who were further along in their pregnancy and women who smoked more cigarettes on a daily basis demonstrated the least intention to quit. Notably, women in the first trimester showed the greatest intention to quit, suggesting that pregnant women may be most receptive to quitting during their first trimester.     

Promoting engagement with a Stop Smoking Service via pro-active telephone calls

Objectives

What proportion of smokers in a deprived area of London, contacted by telephone, are interested in quitting and accept a referral for cessation support?

Methods

Current smokers from records of general practitioners (GPs) were telephoned; if interested in quitting they were offered a referral to the local Stop Smoking Service (SSS) and smoking status was assessed after 6 months.

Results

Over half of current smokers (53%) were interested in receiving help to stop and 39% accepted a referral to the SSS. Six months later 21% of those contacted reported not smoking. Over one-quarter (28%) of those referred set a quit date with the service and 39% of these were recorded as abstinent four weeks after their quit date.

Conclusion

Calling smokers from GP lists appears to offer promise as a means of prompting quit attempts and ensuring that the chances of these quit attempts succeeding are maximized through attendance at NHS SSS.

Practice implications

GP records need to be accurate and maintained. Smoking patients can be contacted by telephone, informed about the availability of local cessation services and referred directly.     

The process of smoking cessation: an analysis of precontemplation, contemplation, and preparation stages of change

Traditionally smoking cessation studies use smoker and nonsmoker categories almost exclusively to represent individuals quitting smoking. This study tested the transtheoretical model of change that posits a series of stages through which smokers move as they successfully change the smoking habit. Subjects in precontemplation (n = 166), contemplation (n = 794), and preparation (n = 506) stages of change were compared on smoking history, 10 processes of change, pretest self-efficacy, and decisional balance, as well as 1-month and 6-month cessation activity. Results strongly support the stages of change model. All groups were similar on smoking history but differed dramatically on current cessation activity. Stage differences predicted attempts to quit smoking and cessation success at 1- and 6-month follow-up. Implications for recruitment, intervention, and research are discussed.     

Workplace tobacco policies and smoking cessation practices of physicians

OBJECTIVE: To further our understanding of the workplace smoking policies and smoking cessation practices of physicians in Nigeria. DESIGN: Cross-sectional survey distributed to 619 physicians practicing in two teaching hospitals in southwestern Nigeria. PARTICIPANTS: Three-hundred-seventy-three physicians who returned completed surveys. MAIN OUTCOME MEASURES: Physician's self-reported workplace smoking policies, attitudes toward smoking cessation, and use of recommended smoking cessation guidelines/policies. RESULTS: Physicians rated quitting as "extremely important." The majority assessed their patients smoking status over the past three months (81%) and thought counseling smokers would help them quit (95%). However, < 1% prescribed pharmacotherapy for smoking cessation in the last three months. Significant differences were found in the workplace smoking policies of the two teaching hospitals (p < 0.001). Differences were also found in the attitudes and smoking cessation practices of physicians in Hospital A and Hospital B. CONCLUSIONS: Physicians are aware of smoking and the importance of quitting but few have guidelines/policies to assist their patients with quitting. Workplace smoking policies appear to impact the smoking cessation attitudes and practices of physicians in Nigeria. Encouraging the adoption of workplace smoking restrictions, as well as training physicians to use recommended smoking cessation interventions, is critical to addressing the tobacco epidemic in Nigeria.     

Psychosocial Obstacles to Smoking Cessation Attempts Among Young Adult Sexual Minority Women Who Smoke

Sexual minority women (SMW; i.e., women who identify their sexuality as lesbian, bisexual, or something other than heterosexual) report greater smoking behaviors than their heterosexual counterparts across all ages. We conducted a multivariable regression to examine the correlates of prior smoking cessation attempts and smoking cessation intentions in a sample of young SMW who smoke (N = 338; aged 18–24 years). Covariates included sociodemographic characteristics (i.e., race/ethnicity, sexual identity, age, urbanity), general (i.e., perceived stress), and sexuality-specific (i.e., internalized homophobia) stressors, as well as smoking attitudes and subjective norms. Bisexual women (OR = 1.92, 95% CI: 1.11, 3.31) were more likely than lesbian counterparts to report a prior smoking cessation attempt. Prior cessation attempts were associated with less internalized homophobia (OR = 0.44, 95% CI: 0.27, 0.69) and positive attitudes toward smoking (OR = 2.17, 95% CI: 1.27, 3.70). Smoking cessation intentions in the next month were negatively associated with being a daily smoker (β = –0.14) and attitudes toward smoking (β = –0.19). Based on these findings, we underscore the need to address the risk correlates associated with SMW's quit attempts and include these in cessation interventions.     

A pilot community-based intensive smoking cessation intervention in African Americans: feasibility, acceptability and early outcome indicators

Few intensive and community-based smoking cessation treatment programs have been designed for African-American smokers, a group who experiences numerous health disparities associated with cigarette smoking. The purpose of this study was to examine the feasibility, acceptability and biochemically verified early outcome indicators in a community-based comprehensive smoking cessation program in 50 urban, low- and middle-income African-American smokers. The intervention was an intensive six-session group program delivered in the community and a one-month supply of the transdermal nicotine patch. Results showed 74% of enrolled participants completed the program and 51% of participants were highly adherent to patch use guidelines. Intent-to-treat analyses revealed that 34% of participants were biochemically confirmed as having quit smoking at one month post quit date. Smoking urges and depressive symptoms also declined significantly during the first month. At three- and six-month follow-up, biochemically confirmed quit rates were 22% and 18%, respectively. Adherence to nicotine patch use, higher ratings of the perceived helpfulness of self-monitoring tasks (wrap sheets) and lower depression scores at baseline all significantly predicted quitting success during the first month of treatment (all p's<0.05). Larger studies are warranted to examine targeted treatment elements and individual difference factors to enhance cessation outcomes in African-American smokers.