Association of Current and Lifetime DSM-IV Drug use Disorder Diagnoses to 6-Month Changes in Smoking Behavior in Risky Drinking Smokers: A Pilot Study

Background: Alcohol and other drug use disorders co-occur with cigarette smoking and negatively impact cessation outcomes. Objectives: This study examined the differential effects of current and lifetime DSM-IV drug diagnoses on the 6-month smoking outcomes of 84 untreated heavy drinking smokers who were motivated to quit smoking in the next 6-months. Methods: Generalized estimating equations (GEE) assessed changes in nicotine dependence, readiness to quit smoking, and prevalence of heavy smoking from baseline to 6-months as a function of time, baseline drinking severity, and drug diagnosis. Results: GEE models showed that nicotine dependence and prevalence of heavy smoking decreased over 6-months, irrespective of drug diagnosis and baseline alcohol consumption. Several 3-way interactions were found, showing differences in the rate of change over time in readiness to quit smoking and prevalence of heavy smoking as a function of current versus lifetime drug diagnosis and higher versus lower of baseline alcohol consumption. Conclusions/Importance: Drug diagnoses are common in risky drinking smokers, and significantly impede changes in smoking behavior and motivation to quit. Treatment planning for smoking cessation should include a thorough assessment of current and past drug use behavior to determine the impact on readiness to quit and quit success. Mechanisms of change in smokers with multiple substance use diagnoses should be examined.     

Unaided smoking cessation and predictors of failure to quit in a community sample: effects of gender

The majority of smokers who eventually quit do so without formal treatment, but few studies have examined a range of predictors of cessation among self-quitters and whether they differ depending on smokers' gender. The present study examined predictors of quitting in a community sample of 93 men and 117 women smokers attempting to quit on their own. Smokers were mailed a baseline questionnaire battery, and instructed to complete other measures the first and second day of their quit attempt. No gender difference in quit rates was observed, but predictors of smoking differed between men and women. Among men, alcohol use, caffeine consumption, and negative affect predicted smoking on quit day. Among women, nicotine dependence, age, ethnicity, weight control smoking, and not eating during urges predicted smoking on quit day. Social support seeking was negatively associated with smoking on the quit day among women, but the opposite relationship was obtained for men. Men's smoking 4 months later was predicted by baseline social pressures to quit and use of nicotine replacement therapy (NRT). For women, weight control smoking and trait anxiety predicted smoking at the 4-month follow-up.     

Socioeconomic disparities in quitting smoking and in steps on the smoking cessation pathway among smokers in Italy: findings from the SIDRIAT cohort study

Objectives: The aim of this research was to examine socioeconomic disparities in quitting smoking and the association between socioeconomic status (SES) and steps in the smoking cessation pathway.

Methods: We conducted an 11-year longitudinal cohort study examining the association between SES and quitting smoking among 721 current smokers at baseline. At the follow-up survey there were 466 smokers composed by those who continued smoking since baseline and those who began ore relapsed smoking. Among these we then studied the association between SES and steps on the pathway of quitting: nicotine dependence, motivational factors (expectancy of gains in quality of life after quitting; worries about health; favourable attitudes about smoking), beliefs about quitting (intention to quit smoking within the next 6?months; self-efficacy), and past quitting history.

Results: Smokers with fewer years of education were less likely to quit. Higher nicotine dependence was associated with lower education and with workers classified as managers and professionals, who were also more likely to record favourable smoking attitudes, and to have made ≥1 quit attempts. Manual workers reported lower self-efficacy in quitting, and were less likely to report 6?months of abstinence.

Conclusions: Higher education levels may predict quitting smoking over a long period. Interventions are needed to reduce dependence and to enhance self-efficacy in lower educated smokers, as well as to reduce favourable smoking attitudes among higher occupational classes.     

Correlates of use of electronic cigarettes versus nicotine replacement therapy for help with smoking cessation

Introduction

Electronic- or e-cigarettes are nicotine-delivery devices commonly used by smokers to quit or reduce smoking. At present, not much is known about the characteristics of smokers who specifically try e-cigarettes to quit smoking compared to the nicotine replacement therapy (NRT) products approved by the U.S. Food and Drug Administration (FDA). Determining the characteristics of smokers who are likely to choose e-cigarettes as cessation aids would help develop strategies to impart valid information about e-cigarettes to such smokers as facts regarding the safety and utility of e-cigarettes emerge.

Methods

This study is based on 834 daily smokers [mean age = 45.8 (standard deviation = 13)] from Hawaii. Demographic, smoking- and cessation-related variables were examined as correlates of ever use of e-cigarette only or any FDA-approved NRT product only or both as cessation aids.

Results

Results indicated that younger smokers, non-White smokers, and smokers reporting higher income, lower nicotine dependence, shorter smoking history, and higher lifetime quit attempts were more likely to have tried e-cigarettes but not NRT products for help with smoking cessation.

Conclusion

Smokers who are attracted to use e-cigarettes but not FDA-approved NRT products may differ from smokers who are likely to have used NRT products but not e-cigarettes in terms of demographic (e.g., age, ethnicity) and smoking- or cessation-related characteristics (e.g., nicotine dependence, quit attempts). Given the lack of knowledge regarding the health effects of e-cigarettes and their efficacy as cessation aids, future research needs to continue characterizing smokers who are likely to use e-cigarettes for smoking cessation.     

Individual and family factors associated with intention to quit among male Vietnamese American smokers: implications for intervention development

Smoking prevalence among Vietnamese American males remains higher than the U.S. general population. This study examined the associations of individual and family factors with quit intention among Vietnamese male smokers in California to guide intervention development to reduce their smoking prevalence. Data for Vietnamese male current smokers (n=234) in the 2008 California Vietnamese Adult Tobacco Use Survey (N=1101 males) were analyzed to describe quit intention and previous quit attempts. One-third of Vietnamese male smokers (33%) had no intention to quit at any time, 36% intended to quit soon (in the next 30 days), and 31% intended to quit later (beyond the next 30 days). Half (51.7%) of the sample was in "precontemplation," indicating no intention to quit within 6 months. Many (71%) had made a serious quit attempt in the past year, but 68% of those who tried to quit used no cessation assistance. Multivariate logistic regression adjusting for age, depression, smoking intensity, nicotine dependence, health knowledge, children in the household and home smoking ban revealed that having smoking-related family conflicts and a quit attempt in the past year with or without assistance were independently associated with an intention to quit either in the next 30 days or later. Higher education was associated with no intention to quit. Findings underscore the importance of designing strategic interventions that meet the needs of smokers at both individual and family levels to promote quit intention and to facilitate successful quitting in this population.     

Nicotine dependence and attempts to quit or cut down among young adult smokers

AIMS: To describe tobacco smoking behaviours, attempts to cut down or quit, and estimate the prevalence of DSM-IV nicotine dependence among young adult smokers. To relate these findings to population demand for national Quitline services. METHODS: Confidential interviews were conducted during the assessment of the Dunedin Multidisciplinary Health and Development Study birth cohort at age 26 years. Current smokers who had smoked daily for at least one month during the twelve months before interview were asked questions to identify nicotine dependence, based on DSM-IV criteria. RESULTS: Overall, 40% (n = 386) of the cohort followed up were current smokers who met the twelve month daily smoking criterion, one third of whom fulfilled DSM-IV criteria for nicotine dependence. The mean number of attempts to quit or cut down in the past year was 1.2. Assuming that each attempt represents a potential call to the Quitline, more than 5500 calls per month might be anticipated from the 25-29 year age group and in excess of 40 000 from the total New Zealand population, eighteen years and older. CONCLUSIONS: Results indicate that many young adult smokers are potential users of smoking cessation services and many are nicotine dependent. In order to satisfy this reservoir of need and reduce the population burden of ill-health and premature death due to tobacco smoking, resources should continue to be provided to support and enhance tobacco control programmes with proven effectiveness in helping smokers to quit.     

Individual differences in adoption of treatment for smoking cessation: demographic and smoking history characteristics

BACKGROUND: Behavioral and pharmacological treatments have been shown to improve smoking cessation rates, but treatments are under-utilized. AIMS: To examine the demographic and smoking history characteristics associated with adoption of treatment for cessation. DESIGN: Analysis of the 2003 tobacco use special cessation supplement to the current population survey. PARTICIPANTS: Representative sample of 12,027 U.S. daily smokers ages 18 and older who made a quit attempt in the past year. MEASUREMENTS: Use of behavioral, pharmacological or alternative treatments for cessation; demographic variables (age, gender, ethnicity, education and income) and measures of nicotine dependence. RESULTS: Females, Whites, older, more educated and wealthier smokers were more likely to adopt treatment in a quit attempt, as were more nicotine dependent smokers. Females were more likely than males to use behavioral treatments. Females and more educated smokers were more likely to combine behavioral and pharmacological treatment. Among those who used only one treatment, males, older and more nicotine dependent smokers were more likely to adopt pharmacological treatments. CONCLUSIONS: The majority of smokers make quit attempts without the benefit of proven behavioral or pharmacological treatments. Efforts are needed to increase use of smoking cessation treatments among all smokers, particularly combination treatment.     

Past alcohol problems do not predict worse smoking cessation outcomes

Whether smokers with a past history of alcohol problems are less able to stop smoking and have a greater need for nicotine replacement therapy than smokers without this history is unclear. We conducted a secondary analysis of a prior study of 1039 smokers randomized to 0, 21, 35 or 42 mg/day nicotine patch for smoking cessation. Because higher dose patches were being tested, only smokers of > or =30 cigs/day were included. Although smokers with current alcohol abuse or dependence were excluded, 15% of the smokers had a past (>1 year ago) Short Alcohol Dependence Data (SADD) score of > or =9 suggesting past alcohol problems. Heavy smokers with a past history of alcohol problems did not relapse sooner, were not less likely to be abstinent and did not benefit more from nicotine treatment or from higher doses than heavy smokers without this history. We conclude that a past history of alcohol problems per se does not predict inability to stop smoking.     

The effects of a prison smoking ban on smoking behavior and withdrawal symptoms

This study investigated symptoms of distress and nicotine dependence as predictors of nicotine withdrawal symptoms among 188 incarcerated male smokers during a mandated smoking ban. Participants completed a smoking history questionnaire and measures of nicotine dependence, withdrawal, cravings, and distress before the ban and two follow-up times. The majority of smokers (76%) continued to smoke following the smoking ban. Smokers after the ban were more nicotine dependent than were the participants who reported quitting. Smokers also reported more withdrawal symptoms than did participants who quit, even when accounting for nicotine dependence and baseline withdrawal scores. An interaction was found such that distressed smokers had the highest level of nicotine withdrawal. These results have implications for how smoking bans are instituted in prison settings.     

Motivational factors related to quitting smoking among prisoners during a smoking ban

Motivational factors and initial stages of change (precontemplation vs. contemplation) were investigated among incarcerated male smokers forced to quit smoking due to a statewide smoking ban. All smokers completed a baseline questionnaire, which assessed smoking history, nicotine dependence [Fagerstrom Test for Nicotine Dependence (FTND)], nicotine withdrawal [Hughes-Hatsukami Withdrawal Scale (HHWS)], and depression [Center for Epidemiological Studies on Depression (CES-D)]. These measures were given again 4 days (Time 2) and 1 month (Time 3) following the smoking ban. At baseline (n=314), 31.2% of smokers were contemplating quitting within 6 months (contemplators), while the majority of smokers (68.8%) indicated they had not considered quitting (precontemplators). Contemplators at Time 2 reported more success with quitting smoking than precontemplators, although this was no longer significant by Time 3. Logistic regression was used to determine the probability of determining initial stages of change based on demographic and smoking history variables. Smokers in precontemplation scored higher on the FTND, reported less agreement with the smoking policy at baseline, reported more difficulty with their previous quit attempts, and reported increased smoking in anticipation of the smoking ban. The risk of being a precontemplator was over twice as high for smokers who reported increasing the amount they smoked prior to the smoking ban (odds ratio=2.42). Overall, this model correctly classified 70.7% of the smokers. This suggests that initial stages of change plays an important role in eventual quitting even in environments in which smoking has been recently prohibited.     

Predictors of tobacco quit attempts among recovering alcoholics

Reported here are findings from a randomized community intervention trial that followed 90 recovering alcoholic smokers for 6 months. Because the brief (10-min) study intervention had no effect on tobacco use, intervention and control participants were pooled to identify predictors of attempts to quit smoking that may inform clinical practice. During the first 6 months after discharge from residential alcohol treatment, 31% of all participants reported having quit smoking for 48 hrs or longer. Demographic and drug use history variables did not predict quit attempt, but two baseline tobacco use variables did, specifically the Fagerstrom Test for Nicotine Dependence and stage of readiness to quit smoking, p < .01. Participants with high or very high nicotine dependence scores were significantly less likely than those with moderate or low scores to attempt smoking cessation. Compared to those in precontemplation at baseline, those in the preparation stage of readiness to change were about 12 times more likely to make a serious quit attempt.     

A comparison of recovering alcoholic and non-alcoholic smokers.

Whether smokers with a positive past history (PH) of alcohol dependence need more intensive or different treatment than smokers with no such history (NH) is unclear. We surveyed 31 PH smokers and 31 age and sex-matched NH smokers to examine differences in motivations for and barriers to stopping smoking. The final regression model found that PH and NH smokers did not differ in social support, social pressure, readiness to quit or physical consequences of smoking; however, PH smokers were more dependent on nicotine and had more internal (affective) barriers to cessation than NH smokers. Although our results require replication due to our small sample size, they do suggest that PH smokers would especially benefit from medications for nicotine dependence and medications or psychosocial treatments for depression.     

Predictors of reduced smoking quantity among recovering alcohol dependent men in a smoking cessation trial

IntroductionAdults with alcohol dependence (AD) have exceptionally high smoking rates and poor smoking cessation outcomes. Discovery of factors that predict reduced smoking among AD smokers may help improve treatment. This study examined baseline predictors of smoking quantity among AD smokers in a pharmacotherapy trial for smoking cessation.MethodsThe sample includes male, AD smokers (N = 129) with 1–32 months of alcohol abstinence who participated in a 12-week trial of medication (topiramate vs. placebo) and adjunct counseling with 6 months of follow-up. Baseline measures of nicotine dependence, AD severity, psychopathology, motivation to quit smoking, and smoking-related cognitions were used to predict smoking quantity (cigarettes per day) at post-treatment and follow-up.ResultsOverall, the sample had statistically significant reductions in smoking quantity. Greater nicotine dependence (Incidence rate ratios (IRRs) = 0.82–0.90), motivation to quit (IRRs = 0.65–0.85), and intrinsic reasons for quitting (IRRs = 0.96–0.98) predicted fewer cigarettes/day. Conversely, greater lifetime AD severity (IRR = 1.02), depression severity (IRRs = 1.05–1.07), impulsivity (IRRs = 1.01–1.03), weight-control expectancies (IRRs = 1.10–1.15), and childhood sexual abuse (IRRs = 1.03–1.07) predicted more cigarettes/day.ConclusionsSmokers with AD can achieve large reductions in smoking quantity during treatment, and factors that predict smoking outcomes in the general population also predict greater smoking reductions in AD smokers. Treatment providers can use severity of nicotine dependence and AD, motivation to quit, smoking-related cognitions, and severity of depression to guide treatment and improve outcomes among AD smokers.     

The hardening hypothesis: is the ability to quit decreasing due to increasing nicotine dependence? A review and commentary

The "hardening hypothesis" states tobacco control activities have mostly influenced those smokers who found it easier to quit and, thus, remaining smokers are those who are less likely to stop smoking. This paper first describes a conceptual model for hardening. Then the paper describes important methodological distinctions (quit attempts vs. ability to remain abstinent as indicators, measures of hardening per se vs. measures of causes of hardening, and dependence measures that do vs. do not include cigarettes per day (cigs/day).) After this commentary, the paper reviews data from prior reviews and new searches for studies on one type of hardening: the decreasing ability to quit due to increasing nicotine dependence. Overall, all four studies of the general population of smokers found no evidence of decreased ability to quit; however, both secondary analyses of treatment-seeking smokers found quit rates were decreasing over time. Cigs/day and time-to-first cigarette measures of dependence did not increase over time; however, two studies found that DSM-defined dependence appeared to be increasing over time. Although these data suggest hardening may be occurring in treatment seekers but not in the general population of smokers, this conclusion may be premature given the small number of data sets and indirect measures of quit success and dependence in the data sets. Future studies should include questions about quit attempts, ability to abstain, treatment use, and multi-item dependence measures.     

Mechanisms of adolescent smoking cessation: roles of readiness to quit, nicotine dependence, and smoking of parents and peers

Multiple levels of influence should be considered in interventions aimed at the adolescent smoker, including psychological, addiction, peer and parental influences. However, the mechanism by which these variables influence the process of smoking cessation in adolescents is not well elucidated. Therefore, this prospective study tested two models among 850 adolescent smokers, specifying the direct and indirect relations between adolescents' readiness to quit smoking, levels of nicotine dependence, and smoking behavior of their parents and friends. One year later smoking cessation was assessed. Results showed that, among adolescent smokers, readiness to quit was positively associated with quit attempts, while nicotine dependence was inversely associated with successful cessation. Instead of a direct relation, parental and peers' smoking were inversely related to smoking cessation through nicotine dependence. The findings emphasize that interventions should be developed and tested within and outside the school setting, as well as within the family situation. In addition, the strong impact of nicotine dependence on successful cessation indicates that a more direct approach is needed to lower nicotine dependence among adolescents.     

Relationship between Tobacco Use and Health-Related Quality of Life (HRQoL) among Clients in Substance Use Disorders Treatment

We examined relationships of smoking status and tobacco-related variables with health-related quality of life (HRQoL), a metric of disease burden, among clients in substance use disorders (SUDs) treatment. Participants (N = 2,068; 46.6% female) completed surveys reporting demographics, smoking status, and past-month days they experienced physical and/or mental health distress. Smokers (n = 1,596; 77.2% of sample) answered questions on tobacco-related variables. Multinomial regression models assessed relationships between tobacco-related variables (smoking status, nicotine dependence, menthol smoking, electronic-cigarette use, health concerns, and cost as reasons affecting reducing/quitting smoking, past and future quit attempts) with HRQol in four categories (good health, physical health distress, mental health distress, or both physical and mental health distress). Current smokers were more likely than former smokers to report frequent physical and mental health distress than good health (OR = 1.97, 95% CI = 1.16, 3.34), as were smokers with higher nicotine dependence (OR = 1.18, 95% CI = 1.03, 1.35). Smokers reporting both frequent physical and mental health distress were more sensitive to cigarettes’ cost (OR = 1.56, 95% CI = 1.06, 2.29), and less likely to use e-cigarettes (OR = 0.59, 95% CI = 0.38, 0.94). Findings of poor HRQoL among nicotine-dependent smokers with additional SUDs strengthen the imperative to provide smoking cessation interventions in addictions treatment.     

The nicotine withdrawal assessment for youth: initial instrument validation and psychometric properties

Within the field of adolescent tobacco use, there does not exist a consistently used and validated measure of adolescent nicotine withdrawal symptoms. The purpose of this study was to evaluate the psychometric properties of the Nicotine Withdrawal Assessment for Youth (N-WAY), a new measure of adolescent nicotine withdrawal symptoms. Smokers and nonsmokers, ranging from 13 to 19 years old, were administered the N-WAY and other smoking information questionnaires in order to examine its reliability and validity. The N-WAY demonstrated satisfactory test-retest reliability (r=0.74-88) and internal consistency (Cronbach's α=0.90-0.92). Its total symptom score accurately discriminated current smokers from nonsmokers. The N-WAY was demonstrated to measure a construct different than nicotine dependence symptoms while correlates of nicotine withdrawal symptoms, such as number of daily cigarettes smoked and prior quit attempts, accurately predicted total N-WAY symptom and impact scores. Preliminary results indicate the N-WAY is a reliable and valid assessment of adolescent nicotine withdrawal symptoms among current smokers.     

Nonclinical panic attack history and smoking cessation: an initial examination

The present study evaluated the association of nonclinical panic attacks among regular smokers with the duration of past quit attempts as well as the type and intensity of DSM-IV smoking withdrawal symptoms. As hypothesized, smokers with a history of panic attacks reported significantly shorter quit attempts compared to their nonpanic counterparts. Additionally, smokers with a history of panic relative to their nonpanic counterparts reported more intense affective reactions during their last quit attempt in regard to anxiety-related but not other types of smoking withdrawal symptomatology. These findings are discussed in regard to the role of negative affect vulnerability factors in smoking cessation with specific reference to panic attacks.     

Smoking among adults reporting lifetime depression,anxiety, anxiety with depression,and major depressive episode,United States, 2005–2006

Objectives

To describe rates of current smoking among persons with and without lifetime anxiety, depression, anxiety with depression, or major depressive episode.

Methods

Data on 73 024 adult respondents from the 2005–2006 National Survey on Drug Use and Health were used to examine smoking status, intensity, frequency, dependence, and quit rates among persons with and without self-reported lifetime history of depression, anxiety, anxiety with depression, or major depressive episode (LDAMDE).

Results

Of persons with LDAMDE, 33% were current smokers, while 22.5% of persons who did not report LDAMDE were current smokers. Persons with LDAMDE were heavier and more frequent smokers and had lower quit rates and higher dependence compared to persons with no LDAMDE.

Conclusions

Compared to persons with no LDAMDE, persons with LDAMDE are more likely to be current smokers, smoke with higher intensity and frequency, have more dependence, and have lower success at quitting. The present study further underscores the need to address nicotine dependence as well as underlying mental health conditions that are known to be comorbid with smoking.