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1.
BACKGROUND: Concerns about weight gain have been a commonly cited barrier to cessation among white, affluent, female populations, but less is known about this relationship among minority smokers and those with low incomes. Although smoking cessation is strongly encouraged for this population, it often leads to weight gain. Cultural differences in weight standards and the high prevalence of weight-related health conditions (e.g., hypertension and diabetes) may influence concerns about smoking cessation-related weight gain. METHODS: A secondary analysis of low-income African-American smokers (n=367) from a randomized intervention trial was conducted to explore the association of weight concerns with comorbidities and smoking cessation. RESULTS: Less than one quarter of participants were considered concerned about weight, defined as having high general concern about weight and high expectation of post-cessation weight gain. Those for whom weight gain could be riskiest--obese participants--were least concerned about gaining weight. Further, weight concerns were not associated with successful smoking cessation, quit attempts, confidence in quitting, or desire or readiness to quit. CONCLUSIONS: Because post-cessation weight gain may be a serious health threat for this population, but weight gain was not a concern for these smokers, smoking-cessation interventions for low-income African-American smokers may need to incorporate weight-gain education and prevention.  相似文献   

2.
Weight gain after smoking cessation can lessen the health benefits of, and reduce the incentives for, quitting smoking. Randomized clinical trials of smoking cessation have estimated this weight gain only over short periods of follow-up. We provide an estimate of long-term post-cessation weight gain in the Framingham Heart Study, a prospective observational study. We identified 2001 smokers free of diabetes, cancer, and cardiovascular disease in 1952. Using the parametric g-formula we estimated mean weight in 1972 if all smokers had quit at baseline versus if all had continued smoking. Our estimates were adjusted for demographic, socio-economic, and clinical factors at baseline and during follow-up. The estimated mean weight (95 % CI) at 20 years if all smokers had quit smoking was 75.2 kg (73.5, 76.6), compared with 70.2 kg (68.7, 71.8) if they had smoked 20 cigarettes/day and 73.4 kg (71.9, 74.6) if they had smoked 5 cigarettes/day (i.e., an estimated mean weight gain of 5.1 kg (3.1, 6.6) and 1.8 kg (0.8, 2.8), respectively). Smokers who were overweight or obese at baseline had a greater post-cessation weight gain on average. Our estimates suggest that smoking cessation can result in increases in body weight over 20 years. While the benefits of smoking cessation outweigh the risks due to post-cessation weight gain, our results highlight the need for long-term weight management interventions in combination with smoking cessation.  相似文献   

3.
BACKGROUND. Weight gain after smoking cessation is often cited by women smokers as a primary reason for not attempting to quit smoking or for relapsing after a cessation attempt. METHODS. A randomized trial of 417 women smokers was conducted to test the addition of two weight control strategies to a smoking cessation program. Participants received the standard smoking cessation program, the program plus nicotine gum, the program plus behavioral weight control, or the program plus both nicotine gum and behavioral weight control. Weight and smoking status were measured at the end of treatment and at 6 and 12 months posttreatment. RESULTS. Smoking cessation rates were highest in the group receiving the smoking cessation program plus nicotine gum. Weight gain did not vary by treatment condition, so its effect on relapse could not be examined by group. There was no significant relationship between weight gained and relapse in individuals. CONCLUSIONS. The added behavioral weight control program was attractive to the participants and did not reduce smoking cessation rates. However, it did not produce the expected effect on weight, thereby restricting our ability to examine the effect of weight control on smoking cessation and relapse.  相似文献   

4.
Understanding the phenomenon of heavy smoking among women and factors related to it is of considerable public health importance. Whereas lighter smokers have been more successful in their cessation attempts, the percentage of smokers who smoke more than 25 cigarettes per day has increased in recent years. This article examines the hypothesis that, compared to lighter smokers, female heavy smokers will report more responsiveness to internal cues to smoke, less interest in quitting, more difficulty with previous cessation attempts, more uncertainty about cessation strategies, and more concern about weight gain as a result of quitting. We collected data in 1984 through a self-administered survey completed by 874 women employed as nurses in acute care, chronic care, and home care nursing in Worcester, Massachusetts; we base our analyses on data collected from 158 light and moderate smokers and 67 heavy smokers. Our findings suggest that, compared to lighter smokers, heavy smokers may depend more on nicotine and are likely to respond to a broader array of cues to smoke, factors that appear to contribute to heavy smokers' greater difficulties with quitting. These female heavy smokers are just as likely as lighter smokers to have made previous attempts to quit and want to quit just as much. Major barriers to quitting for female heavy smokers include a lack of confidence in their ability to quit, insufficient tools to succeed with cessation attempts, and fear that weight gain will accompany quitting.  相似文献   

5.
The present study sought to determine whether postcessation weight gain concerns influenced pretreatment attrition differently for pre- versus postmenopausal women smokers. Participants were pre- and postmenopausal women smokers drawn from two clinical trials for smoking cessation and weight gain prevention [the Smoking Treatment/Obesity Prevention (STOP) studies]. Predictors of attrition from baseline assessment visits prior to entering smoking cessation treatment were identified among these women. Pretreatment attrition was significantly higher among the premenopausal women. The premenopausal women had significantly higher weight concern but lower restraint and disinhibition than the postmenopausal women. Weight concern explained variance in treatment attrition from the programs, while controlling for variables such as Body Mass Index (BMI), smoking rate, number of years smoking, nicotine dependence level, dietary restraint, disinhibition, and hunger, such that the higher the weight concern, the more likely women were to drop out of treatment programs prior to a quitting attempt.  相似文献   

6.
OBJECTIVE: To assess the relevance of pre-existing body weight for successful smoking cessation among women and men. METHODS: We carried out a retrospective cohort analysis among 4270 ever smoking participants of a general health screening examination in Germany recruited from July 2000 to June 2002 aged 50 to 74, who provided lifetime histories of both body weight and smoking. RESULTS: In the extended Cox model, the relative cessation rate (RCR) increased significantly with increasing body mass index (BMI) among both genders (test for trend: P < 0.01 for women and P < 0.0001 for men). In women, this effect was mainly due to a lower cessation rate in low-weight (BMI <20) smokers (adjusted RCR = 0.76, 95% confidence interval (CI) 0.62-0.95), whereas in men, the effect was mainly due to a higher cessation rate among overweight and obese smokers (adjusted RCR = 1.26, 95% CI 1.11-1.35, and 1.38, 95% CI 1.17-1.63, respectively) compared to normal-weight smokers. CONCLUSIONS: While in men, overweight and obesity are associated with increased smoking cessation, possibly related to increased health concerns, in women, low weight is associated with decreased smoking cessation, possibly related to increased fear of weight gain.  相似文献   

7.
PURPOSE: To assess the relationship among weight concerns, smoking, and perceived difficulty in quitting among Argentinean adolescents. METHODS: Logistic regression and profile analyses, stratified by sex, were used to estimate the associations among 8th and 11th grade students (n=2524). RESULTS: Weight concerns were associated with current smoking status and also with perceived quitting difficulty among female, but not male, Argentinean high school students. Profile analyses determined parallel profiles of weight concerns between female smokers and nonsmokers and between male smokers and nonsmokers. CONCLUSIONS: The presence of weight concerns among adolescent females may require special consideration in smoking prevention and cessation programs.  相似文献   

8.
RESEARCH OBJECTIVE: To estimate the effect of provider advice in routine clinical contacts on patient smoking cessation outcome. DATA SOURCE: The Sample Adult File from the 2001 National Health Interview Survey. We focus on adult patients who were either current smokers or quit during the last 12 months and had some contact with the health care providers or facilities they most often went to for acute or preventive care. STUDY DESIGN: We estimate a joint model of self-reported smoking cessation and ever receiving advice to quit during medical visits in the past 12 months. Because providers are more likely to advise heavier smokers and/or patients already diagnosed with smoking-related conditions, we use provider advice for diet/nutrition and for physical activity reported by the same patient as instrumental variables for smoking cessation advice to mitigate the selection bias. We conduct additional analyses to examine the robustness of our estimate against the various scenarios by which the exclusion restriction of the instrumental variables may fail. PRINCIPAL FINDINGS: Provider advice doubles the chances of success in (self-reported) smoking cessation by their patients. The probability of quitting by the end of the 12-month reference period increased from 6.9 to 14.7 percent, an effect that is of both statistical (p < .001) and clinical significance. CONCLUSIONS: Provider advice delivered in routine practice settings has a substantial effect on the success rate of smoking cessation among smoking patients. Providing advice consistently to all smoking patients, compared with routine care, is more effective than doubling the federal excise tax and, in the longer run, likely to outperform some of the other tobacco control policies such as banning smoking in private workplaces.  相似文献   

9.
BACKGROUND. Smoking among young women is associated with a variety of negative health outcomes. Gender specific influences on smoking, quitting and attempting to quit are hypothesized to occur and may have implications for cessation programs. METHODS. Telephone surveys were conducted in a large (n = 6,711) cohort of young men and women (average age 19.2 years) which was first established in 1979 and has been resurveyed several times since then. Questions concerned smoking, successful and unsuccessful attempts to quit, withdrawal symptoms during quit attempts, and concerns about quitting. RESULTS. More women than men reported current smoking (26.5 vs 22.6 percent), but quitting attempts, successful and unsuccessful, were equally common. Withdrawal symptoms were reported equally, except for wanting to eat more than usual and weight gain, both of which were reported more often by women than men. Women smokers reported substantially more concern about weight gain if they quit smoking (57.9 vs 26.3 percent expressing concern). CONCLUSIONS. Targeted programs are needed to address issues of concern to young women smokers, particularly fear of gaining weight.  相似文献   

10.

Background

To support health policy makers in setting priorities, quantifying the potential effects of tobacco control on the burden of disease is useful. However, smoking is related to a variety of diseases and the dynamic effects of smoking cessation on the incidence of these diseases differ. Furthermore, many people who quit smoking relapse, most of them within a relatively short period.

Methods

In this paper, a method is presented for calculating the effects of smoking cessation interventions on disease incidence that allows to deal with relapse and the effect of time since quitting. A simulation model is described that links smoking to the incidence of 14 smoking related diseases. To demonstrate the model, health effects are estimated of two interventions in which part of current smokers in the Netherlands quits smoking. To illustrate the advantages of the model its results are compared with those of two simpler versions of the model. In one version we assumed no relapse after quitting and equal incidence rates for all former smokers. In the second version, incidence rates depend on time since cessation, but we assumed still no relapse after quitting.

Results

Not taking into account time since smoking cessation on disease incidence rates results in biased estimates of the effects of interventions. The immediate public health effects are overestimated, since the health risk of quitters immediately drops to the mean level of all former smokers. However, the long-term public health effects are underestimated since after longer periods of time the effects of past smoking disappear and so surviving quitters start to resemble never smokers. On balance, total health gains of smoking cessation are underestimated if one does not account for the effect of time since cessation on disease incidence rates. Not taking into account relapse of quitters overestimates health gains substantially.

Conclusion

The results show that simulation models are sensitive to assumptions made in specifying the model. The model should be specified carefully in accordance with the questions it is supposed to answer. If the aim of the model is to estimate effects of smoking cessation interventions on mortality and morbidity, one should include relapse of quitters and dependency on time since cessation of incidence rates of smoking-related chronic diseases. A drawback of such models is that data requirements are extensive.  相似文献   

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