Gender differences in cigarette smoking and quitting in a cohort of young adults.

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.     

Smoking cessation and long-term weight gain in the Framingham Heart Study: an application of the parametric g-formula for a continuous outcome

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.     

Race differences in the proportion of low birth weight attributable to maternal cigarette smoking in a low-income population

PURPOSE: To quantify race differences in the public health impact of maternal cigarette smoking on infant birth weight and to estimate the proportion of low birth weight births that could be prevented by maternal smoking cessation. DESIGN: A cohort that consisted of 77,751 mother-infant pairs was evaluated retrospectively. SETTING: Statewide study of Women, Infants and Children participants in North Carolina. SUBJECTS: African-American and non-Hispanic white women who delivered a single live infant during 1988, 1989, or 1990. MEASURES: Logistic regression estimates of the relative risk of low birth weight births for smokers were used to calculate adjusted population attributable risk percentages for smoking. Separate population attributable risk percentages were calculated for total low birth weight, moderately low birth weight, and very low birth weight, and all estimates were adjusted for prepregnancy body mass index, gestational weight gain, age, education, parity, and timing of entry into prenatal care. RESULTS: Non-Hispanic whites had a much higher prevalence of smoking and were heavier smokers than African-Americans. For both moderately low birth weight and very low birth weight, the population attributable risk percentages for smoking were twice as high for non-Hispanic whites than for African-Americans. Overall, after adjustment, 30.7% of low birth weight births among non-Hispanic whites and 14.4% of low birth weight births among African-Americans were attributable to smoking. CONCLUSIONS: Although the public health impact of maternal cigarette smoking on infant birth weight was twice as high for non-Hispanic whites as for African-Americans in this low-income population, smoking cessation by all low-income pregnant women would result in significant improvements in infant health and well-being.     

Weight concerns and smoking in a general population: the Inter99 study

OBJECTIVE: No previous studies have explored weight concerns in relation to smoking habits, or investigated how weight concerns affect smoking cessation in a general population. METHOD: Inter99 is a population-based lifestyle interventional study, conducted in 1999-2001 in Copenhagen, Denmark, comprising 30-60 year old men and women. All daily smokers (N=2408) were offered help to quit. The baseline investigation (N=6784) was used for analysing associations of smoking status with weight concerns (cross-sectional design). To analyse how weight concerns affected smoking cessation we included the 1387 daily smokers attending 1-year follow-up; 221 of these were verified quitters (longitudinal design). RESULTS: Daily smoking men and women had a significantly lower body mass index than never smokers (men: 3%, women 5%) but reported to be significantly less concerned of their weight (men: OR=0.64, 95%CI=0.4-0.9), women: 0.78(0.6-1.0)). Ex-smoking normal weight women were significantly more likely to be frequently concerned of their weight than never smoking normal weight women (OR=2.06, 95CI%=1.6-2.7). Fifty-two percent of the women and 32% of the men with a previous quit attempt reported that weight gain was a reason for relapse. Neither weight concerns nor eating patterns were predictive of point abstinence at 1-year follow-up. CONCLUSION: Smokers are believed to be very concerned of their weight but in this population-based study, daily smokers more frequently ate what they wanted, had a lower BMI and were significantly less concerned of their weight than never smokers. Weight concerns and eating patterns did not predict abstinence at 1-year follow-up. It seems that weight gain and weight concerns are independent factors.     

Heavy smoking among a sample of employed women.

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.     

Continuation of smoking cessation and following weight change after intervention in a healthy population with high smoking prevalence

Smoking prevalence among males is conspicuously high in Asian countries including Japan. There are few prospective intervention studies on the duration of smoking cessation within regions with a high prevalence of smokers, such as Asia. We investigated the extent to which subjects continued abstaining from smoking after receiving smoking cessation support provided for all smokers in an occupational setting, regardless of their willingness to quit smoking. The subjects were 251 male workers who were smokers and had received a smoking cessation intervention in 1997 in an occupational setting. Smoking cessation rates and body mass index (BMI) at 10, 18, 30, 42, 54, and 66 months after the initial intervention were confirmed during annual health check-ups. Those who quit smoking following the intervention and continuously abstained from smoking throughout the study period were separately examined for BMI. After five years, 10.6% of the smokers continued smoking cessation. Of the abstainers who quit following the intervention, the abstinence rate decreased in the first and second year, but it stabilized at approximately 45% after the third year. High nicotine dependence and a self-reported lack of willingness to quit smoking did not lower long-term abstinence rates. Abstainers initially gained 1.55 BMI on average, but decreased the weight gain to 0.96 BMI over six years. Introducing smoking cessation support without nicotine replacement therapy is an effective long-term strategy in a healthy population with a high smoking prevalence. Abstainers maintain their smoking cessation if they refrain from smoking for three years.     

Smoking habits and smoking cessation among North Carolina nurses

A 1987 questionnaire survey of a 1% random sample (n = 356) of registered nurses in North Carolina provided data on the smoking habits and smoking cessation. Fifty-six percent were never smokers; 19% were current smokers. Among the ever smokers, 31% had quit smoking for at least one year. Twenty-two percent of the former smokers had smoked less than 5 years and 39% less than 10 years before quitting. Anecdotal notes from never smokers suggested that their major deterrent to smoking was their own parents smoking. Concerns about the addictive smoking behavior and health effects of smoking observed in their parents as well as concerns about potential health risks to themselves deterred them from smoking. Concerns about the adverse consequences of smoking was the most influential factor influencing smoking cessation and reduction of cigarette smoking. Friends' and family's encouragement to stop smoking was the most influential external factor motivating nurses to quit or reduce cigarette consumption. Fifty-seven percent of the former smokers quit smoking after one or two attempts while 53 of the current smokers had tried to quit 3 or more times - 90% had tried at least once to quit smoking; however, only 18% of the current smokers had abstained for more than one year during any of their attempts to quit. Implications of the results include: (1) smoking cessation programs for nurses in the workplace may have considerable impact since the majority of nurses who smoke are tying to quit; (2) relapse prevention strategies need to be an integral part of such smoking cessation programs including involvement of family and friends to support the smokers in their cessation efforts.     

Evaluation of a smoking cessation intervention for pregnant women in an urban prenatal clinic

A smoking cessation and relapse prevention intervention was tested in an urban, prenatal clinic serving predominantly low-income, African-American women. At their first prenatal visit, 391 smokers were randomly assigned to an experimental (E) group to receive usual clinic information plus a prenatal and postpartum intervention or to a control (C) group to receive only usual clinic information. The intervention consisted of individual skills instruction and counseling by a peer health counselor on the use of a self-help cessation guide and routine clinic reinforcement. Among the E group (n = 193), 6.2% were cotinine-confirmed quitters at third trimester and among the C group (n = 198) the quit rate was 5.6%. Quitters were light smokers at entry into prenatal care. Many had tried to quit smoking at least once prior to pregnancy.     

青岛市成人戒烟现况及影响因素分析

目的 分析青岛市成人戒烟状况和戒烟意愿的影响因素。方法 采取多阶段分层随机抽样的方法,在青岛市抽取5 000名15岁及以上的居民,采取入户调查的方式进行问卷调查。根据2010年第六次普查人口加权计算,采用戒烟率、尝试戒烟次数、医生戒烟建议等指标描述戒烟行为,采用复杂抽样Logistic单因素和多因素分析,探讨吸烟者戒烟意愿的影响因素。结果 青岛市成年吸烟者戒烟率为20.2%;吸烟者尝试戒烟和意愿戒烟的比例分别为24.8%和13.5%,54.6%的尝试戒烟者在过去12个月尝试戒烟2次以上;就诊的吸烟者中有66.8%的人接受过医生的戒烟建议。多因素分析显示,在控制其它影响因素后,只有烟草危害知识知晓情况和是否尝试过戒烟会影响戒烟意愿。结论 青岛市人群目前尝试戒烟率较低,应提高戒烟服务的专业性和可及性,促进吸烟者尝试戒烟,同时制定针对性的控烟宣传策略,提高未来戒烟意愿。     

Obesity in relation to smoking: A population study of women in Göteborg,Sweden

A population sample of 1,462 middle-aged women (participation rate 90.1%) was studied in 1968–1969, 1,302 of whom (participation rate 80.3%) were reexamined in 1974–1975. Cigarette smoking was more frequent among younger women. Current smokers were leaner than nonsmokers. A U-shaped relationship was found between obesity index and cigarette consumption. This relationship was not explained by differences in energy intake, physical activity, or social class. Cessation of smoking was correlated with weight gain, and commencement of smoking with weight loss. Of those who quit 13% gained weight ?10.0 kg and 22% gained between 5.0 and 9.9 kg compared with 4 and 14%, respectively, among those who did not change smoking habits. The average weight change was +3.5 and ?0.7 kg among those who quit smoking and started smoking, respectively, compared with +1.4 kg among those who did not change smoking habits. A greater weight gain with the amount smoked was found both in those who stopped smoking and in those who continued smoking. Increased physical activity and reduced energy intake need consideration at cessation of smoking, especially among heavy smokers. The quantitative aspects of the relationship between smoking and obesity, and between cessation of smoking and weight gain, are considered to be of special interest for health personnel engaged in antismoking campaigns.     

Smoking cessation and body mass index of occupationally active men: the Israeli CORDIS Study

OBJECTIVES: This study estimated weight gain after smoking cessation and identified factors attenuating this gain. METHODS: We conducted a prospective follow-up of 1209 male factory workers for 2 to 4 years. The independent variables were smoking habits. age, sports activity, education, alcohol consumption, ethnicity, duration of follow-up, and body mass index (BMI, kg/m2) at entry. The dependent variable was increase in BMI during follow-up. RESULTS: The mean age-adjusted BMI at entry into the study was 26.6 kg/m2 among past smokers and 25.4 kg/m2 among current smokers. There were no differences in BMI between those who quit less than 3 years before entry and those who quit more than 6 years before entry. During follow-up, the average increase in BMI was 0.07 kg/m2 among never smokers, 0.19 kg/m2 among smokers who had stopped smoking before entry, 0.24 kg/m2 among current smokers, and 0.99 kg/m2 among those who stopped smoking after entry. Cessation of smoking after entry predicted an increased gain in BMI; older age, a higher BMI at entry, sports activity, and alcohol consumption attenuated this gain. CONCLUSIONS: The increased rate of weight gain after smoking cessation is transient. However, the weight gained is retained for at least 6 years.     

Attitudes of adolescents toward smoking cessation.

We surveyed 375 10th grade students on present behaviors regarding cigarette use and on attitudes concerning smoking cessation. Fourteen percent of students were daily smokers and 7% were occasional smokers. Of the daily smokers, 28% said their most important reason for continued smoking was because they were addicted, and 52% reported two or more prior cessation attempts. When asked the most important reasons for wanting to quit, 70% of occasional smokers and 43% of daily smokers listed health as the most important concern. Only daily smokers (22%) wanted to quit because they thought they were addicted. We conclude that daily smokers among adolescents have many characteristics of adult smokers and that intervention efforts among adolescent smokers may need to be tailored differently for such "adult pattern" smokers as compared to occasional smokers, particularly in regard to addressing the question of smoking as an addictive behavior.     

Predictors of pretreatment attrition from smoking cessation among pre- and postmenopausal, weight-concerned women

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.     

Spontaneous cessation of smoking and alcohol use among low-income pregnant women

BACKGROUND: Despite the strong evidence of harmful effects, tobacco and alcohol use during pregnancy continue to be major public health challenges. Some women, however, do stop spontaneously when they learn of their pregnancy. No study has investigated spontaneous cessation of both behaviors in a low-income predominantly unmarried U.S. population. OBJECTIVE: To describe the prevalence of spontaneous cessation of cigarette and alcohol use alone and in combination and associated factors among low-income pregnant women. METHODS: Subjects (N=601) were currently smoking or smoking when they became pregnant and participating in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) programs in the greater Boston, Massachusetts, area. Baseline interviews assessed the factors being studied and the spontaneous cessation of cigarette and alcohol use with pregnancy. Saliva cotinine verified self-reported smoking status.RESULTS: Spontaneous cessation of smoking and alcohol use was reported by 28% and 80% of the women, respectively; 25% spontaneously quit both, and 15% stopped neither. Multivariable analyses indicated that smoking cessation was less likely in women who had previous births, had a husband or partner who smoked, were born in the United States, were black (non-Hispanic, non-Portuguese), had less than a high school education, were highly addicted, reported lower perceived risk to the fetus, and reported "too many other problems in life to stop." Hispanic ethnicity, younger age, and more social support to quit smoking were related to spontaneous alcohol abstinence. CONCLUSIONS: Targeted multiple strategies, including those aimed at increasing participation of partners, are needed for low-income pregnant smokers.     

Validation of a scale for the assessment of food cravings among smokers

Weight gain associated with smoking cessation impedes attempts to quit smoking and may lead to obesity. One factor that might contribute to weight gain is cravings for sweet or rich foods. To date, no reliable measure exists for evaluating these cravings. The purpose of the current study was to validate an assessment of craving for sweet or rich foods for use among smokers. With a sample of 385 smokers enrolled in a clinical trial for smoking cessation, the study examined the factor structure, internal consistency, and convergent and predictive validity of the Questionnaire on Craving for Sweet or Rich Foods (QCSRF). A two-factor model best represented the data. Factor 1 contained six items assessing perceptions about the ability of sweet or rich foods to relieve negative affect and about self-control over eating. Factor 2 contained three items assessing the intensity of cravings. Both factors demonstrated high internal consistency and good convergent and predictive validity. These results suggest the QCSRF is a reliable and valid measure for examining cravings for sweet or rich foods among smokers.     

Smoking, smoking cessation, and use of smoking cessation aids and support services in South Derbyshire, England

OBJECTIVES: To describe smoking behaviour, motivation to quit and quit rates, and the effect of advice and support for smoking cessation among smokers from more and less disadvantaged socio-economic groups in South Derbyshire, a mixed urban and rural area of central England. STUDY DESIGN: Cross-sectional study. METHODS: A cross-sectional study with a random, stratified sample of people aged 25-44 years and people aged 65-74 years with over-sampling of populations living in disadvantaged areas. Main outcome measures included the proportion of smokers wishing to quit and quitting in the last year; reported advice to quit from family and friends and health professionals; and awareness and use of NHS smoking-cessation services. RESULTS: Over half of smokers aged 25-44 years, about one-third of women smokers and 40% of male smokers aged 65-74 years wished to quit. This varied little by socio-economic status. Quit rates were generally lower among smokers of lower socio-economic status (SES), especially among people aged 25-44 years. Smokers of lower SES reported slightly less advice to quit from family and friends, and more so from health professionals. Awareness and use of cessation services was about 30% and 5%, respectively, among smokers and recent quitters. Awareness varied little but accessing services was generally higher among smokers of lower SES. CONCLUSIONS: Despite evidence that health professionals and cessation services were targeting smokers with lower SES and of similar motivation to quit, quit rates were lower. Broader tobacco control interventions targeting the social and environmental contexts that create and maintain socio-economic differentials in smoking are required.     

Smoking-related behavior, beliefs, and social environment of young black women in subsidized public housing in Chicago.

Survey data indicate that young Black female smokers living in public housing are heavier smokers and have weaker motivation to quit, health beliefs and social environment less conducive to cessation, and less knowledge of where to get help to quit than other young Black female smokers in metropolitan Chicago. Compared with White women, the latter, other Black women smoke fewer cigarettes daily and have a stronger desire to quit and more concern about health reasons for quitting, but have a weaker belief in the risk of lung cancer from smoking, greater concern about quitting difficulties, and less knowledge of where to get help to quit. Low education, not race, is associated with higher smoking prevalence and less social pressure to quit or support for quitting.     

The impact of body weight on smoking cessation in German adults

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.     

Nicotine dependence, quit attempts, and quitting among smokers in a regional population sample from a country with a high prevalence of tobacco smoking

BACKGROUND: Nicotine dependence might function as a barrier to smoking cessation. Therefore, the goal was to determine whether single symptoms of nicotine dependence are related to the number of quit attempts and smoking status. METHODS: In a random population sample of 4075 women and men aged 18-64, drawn from 47 German communities, data about nicotine dependence according to the US Diagnostic and Statistical Manual of Mental Disorders and according to the Fagerstr?m Test for Nicotine Dependence (FTND), and data on quit attempts and quitting were collected at baseline with an interview and 30 months later with a questionnaire. RESULTS: Nicotine dependence, in particular withdrawal, was related to a high number of quit attempts and to remaining a current smoker. The urgent need for tobacco, craving for nicotine, smoking to avoid withdrawal, and the expectation of increased appetite or weight gain correctly classified smoking status in 72.1% of individuals through logistic regression analysis. CONCLUSIONS: Nicotine dependence is a strong factor that may partly explain the failure of a subpopulation of smokers to live abstinent. Population-based interventions should include measures of tobacco control and brief interventions carried out, for example, by experts in health care.