Prospective examination of effects of smoking abstinence on cortisol and withdrawal symptoms as predictors of early smoking relapse

This study addressed the hypothesis that exaggerated mood and cortisol changes during the first 24h of smoking abstinence are associated with early relapse. Salivary cortisol levels and mood reports were measured during 24-h ad libitum smoking and the first 24-h abstinence period of a quit attempt. Seventy-two habitual smokers (34 women and 38 men) who were interested in smoking cessation participated. Cotinine concentrations in saliva and expired carbon monoxide were measured before and after abstinence and 1 week after the quit date to verify smoking status. Abstinence produced significant withdrawal symptoms in all participants and reduced cotinine and carbon monoxide levels. While participants showed the expected diurnal changes in cortisol levels, those who relapsed within the first week post quitting exhibited a greater drop in morning cortisol concentrations during abstinence relative to their ad libitum smoking levels. Participants who relapsed reported greater withdrawal symptoms, craving for cigarettes, and distress, and they also reported greater reduction in positive affect during the first 24-h period of abstinence than those who maintained abstinence. These results support the hypothesis that early relapse is associated with exaggerated mood and adrenocortical perturbations observed during the first day of abstinence.     

Smoking cessation among Chinese young smokers: Does gender and age difference matters and what are the predictors?

This study assessed the gender and age differences in smoking cessation among the Chinese youth and identified factors associated with quitting smoking. This was a clinic based cross-sectional study with longitudinal components among 129 Chinese young smokers. All services in the clinic including one week's supply of nicotine replacement therapy (NRT) were free. We used structured questionnaires at baseline and at 1, 3 and 12 months. The analysis was by intention-to-treat basis. At 12 month follow up, the 7 day point prevalence quit rate (abstinence from tobacco smoking during the 7 days preceding the follow up) was 19% (25/129) and 36% (25/69) among all the attendees and among those who were successfully followed up, respectively. There was no significant gender or age differences in the quitting outcome but females and the older youth reported more withdrawal symptoms. Not reporting any withdrawal symptoms at 3 months follow up and adherence to use NRT for at least 4 weeks were significant predictors of quitting. A clinic-based smoking cessation service among Chinese young smokers produced an acceptable quit rate with no gender and age difference, indicating that a more general quit smoking approach could be taken for the youth.     

Cognitive and social influence factors in adolescent smoking cessation

Using a longitudinal design, the current study investigated the roles of smoking-related beliefs, and parent and peer psychosocial factors as antecedents and consequences of adolescent smoking cessation. Results indicated that adolescents who would later quit smoking were different from those who continued to smoke even prior to the transition. For younger subjects, cessation was related mainly to parental influences (e.g., parental support and attitudes towards smoking). Older adolescents responded primarily to peer influences in choosing to quit. While psychosocial factors served as antecedents to cessation, results also indicated that the process of quitting itself led to changes in the adolescents' social environment that further reinforced smoking cessation (e.g., fewer friends who smoked, less positive peer attitudes towards smoking). Thus, the process of smoking cessation among adolescents may be bidirectional, with psychosocial factors influencing the decision to quit and, in turn, being influenced by such a decision.     

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 smoking relapse among self-quitters: a report from the Normative Aging Study.

We followed 235 adults for one year after a self-initiated attempt to stop smoking cigarettes. Relapse rates were much larger than expected in the early days and weeks after the quit attempt. Approximately 62% had relapsed by 2 weeks after their quit dates. Those who smoked any cigarettes at all in the post-cessation period (i.e., lapsed) had a 95% probability of resuming their regular pattern of smoking subsequently. Shorter periods of abstinence on prior quit attempts, greater pre-cessation consumption of alcoholic beverages, and lower pre-cessation levels of confidence in quitting were related to relapse. In addition, abstainers who reported decreased confidence after cessation concerning their ability to maintain abstinence were more likely to relapse thereafter. The presence of a greater proportion of smokers in the subjects' environment also increased the likelihood of relapse. Demographic variables such as age, gender, and education level did not predict relapse. Likewise, neither baseline psychosocial stress levels, nor post-cessation increases in stress were related prospectively to relapse. Clinical implications of finding are discussed.     

Relapse among Cigarette Smokers: The CARDIA longitudinal study - 1985–2011

Rationale

There is little information about long-term relapse patterns for cigarette smokers.

Objective

To describe long-term prevalence of relapse and related smoking patterns by sex, race, age, and education level among a community-based cohort of young adults followed for 25 years.

Methods

We examined 25 years of data from Coronary Artery Risk Development in Young Adults (CARDIA), an ongoing study of a community-based cohort of 5115 men and women aged 18 to 30 years at baseline with periodic re-examinations. At each examination smoking, quitting, and relapse were queried. We examined prevalence of smoking relapse among 3603 participants who attended at least 6 of the 8 examinations.

Results

About 53% of 3603 participants never reported smoking on a regular basis. Among the remaining 1682 ever smokers, 52.8% of those who reported current smoking at baseline were still smoking by the end of the study, compared to 10.7% of those who initiated smoking by year 5. Among those classified as former smokers at baseline, 39% relapsed at least once; of these, 69.5% had quit again by the end of the study. Maximum education level attained, age at study baseline, and race were associated with failure to quit smoking by the end of the study and relapse among those who did quit. Maximum education level attained and age at study baseline were also associated with ability to successfully quit after a relapse.

Conclusions

Smoking relapse after quitting is common, especially in those with lower education level. Education was the strongest predictor of all three outcomes. Improvements in access to treatment and treatment options, especially for underserved populations, are needed to prevent relapse when smokers quit.     

Subjective effects of cigarette smoking in adolescents

Eighty-two per cent of a sample of 170 female adolescent smokers reported experiencing one or more of five specified subjective effects of smoking. Feeling calmer was the most frequently reported effect and daily smokers were more likely to report this than non-daily smokers (64% versus 38%, P<0.001). Self-reports of cigarette consumption and depth of inhalation and measures of smoke intake (salivary cotinine and expired-air carbon monoxide levels) were positively related to the report of feeling calmer when smoking and negatively related to feeling dizzy/light-headed and sick when smoking. The likelihood of experiencing at least one withdrawal effect when trying to quit was greater amongst those who reported feeling calmer when smoking (82% versus 40%, P<0.001). These results indicate that subjective effects of smoking are commonly reported by children and it is possible that pharmacological factors are implicated alongside psychosocial ones even at this early stage.     

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.     

Reasons for Quitting and Smoking Temptation among Adolescent Smokers: Gender Differences

Adolescent cigarette smokers from randomly selected classrooms from 24 California and Illinois high schools were assessed regarding their interest in cessation, reasons for quitting, and smoking temptation circumstances. These data were analyzed by gender. Males and females were not found to differ in quit stage or perceived likelihood of ever quitting smoking, although males reported being somewhat more likely to have ever tried to quit in the past. The associations of reasons for quitting were not found to vary by gender in most comparisons. On the other hand, the associations of smoking temptation circumstances with gender showed that a greater percentage of females than males reported more circumstances that would make them tempted to smoke. Smoking cigarettes to regulate one's affective states, and to avoid nicotine withdrawal, may be functions of smoking that impede efforts at quitting, particularly among adolescent females.     

Testing Social Cognitive Theory as a theoretical framework to predict smoking relapse among daily smoking adolescents

Predictors of adolescent smoking relapse are largely unknown, since studies either focus on relapse among adults, or address (long-term) smoking cessation but not relapse. In the present study, Social Cognitive Theory (SCT) was used as a theoretical framework to examine the first and second lapses, as well as mild and heavy relapse into smoking among 135 daily smoking adolescents who embarked on a serious quit attempt. Baseline predictors were pros of smoking, pros of quitting, self-efficacy, and intensity of smoking. Using an ecological momentary assessment (EMA) study design, participants were monitored three times a day during 4 weeks. A follow-up was administered 2 months after the monitoring period. Perceiving many pros of smoking, reporting a low self-efficacy to quit, and high levels of baseline smoking significantly predicted relapse within 3 weeks after quitting. The effects of pros of smoking and self-efficacy on relapse, however, appeared to be accounted for by differences in intensity of smoking. Besides that pros of quitting showed a marginal effect on abstinence at the 2-month follow-up, no long-term effects were detected.     

Predictors of smoking cessation processes among secondary school students

Many adolescents want to quit and have specific ideas on how they want to go about it. This study extended the search for factors related to different aspects of quitting. Four cross-sectional surveys of Queensland (Australia) secondary schools every three years over the past decade (1993, 1996, 1999, and 2002). A total of 9993 school students in grades 8 to 12 completed the survey. The data for 2451 students who had smoked in the last week (51% female) were used for the analysis of smoking cessation outcomes. The outcome measures for the study represented various smoking cessation outcomes, such as a desire to quit, attempts to quit, quitting for a week or more, and an intention not to be smoking in the following year. More than 60% of adolescent smokers are involved in the process of smoking cessation. The strongest predictor of cessation was whether or not students had actively influenced other students not to smoke. This finding supports the concept of involving adolescents more actively in prompting their peers to try quitting and supporting their efforts to quit smoking.     

Predictors of Smoking Cessation Processes Among Secondary School Students

Many adolescents want to quit and have specific ideas on how they want to go about it. This study extended the search for factors related to different aspects of quitting. Four cross-sectional surveys of Queensland (Australia) secondary schools every three years over the past decade (1993, 1996, 1999, and 2002). A total of 9993 school students in grades 8 to 12 completed the survey. The data for 2451 students who had smoked in the last week (51% female) were used for the analysis of smoking cessation outcomes. The outcome measures for the study represented various smoking cessation outcomes, such as a desire to quit, attempts to quit, quitting for a week or more, and an intention not to be smoking in the following year. More than 60% of adolescent smokers are involved in the process of smoking cessation. The strongest predictor of cessation was whether or not students had actively influenced other students not to smoke. This finding supports the concept of involving adolescents more actively in prompting their peers to try quitting and supporting their efforts to quit smoking.     

Adolescent smoking: epidemiology and approaches for achieving cessation

The initiation of smoking typically occurs during adolescence. To date, most adolescent smoking control efforts have focused on prevention; attempting to identify and influence factors that contribute to experimentation and initiation. However, given the large number of adolescent smokers, it is important that effort also be directed toward facilitating cessation. Many adolescents are addicted to cigarettes and report withdrawal symptoms that are similar to those experienced by adults. Relapse rates are high; few adolescents who try to quit on their own are successful. Clinician-delivered smoking cessation interventions have a positive impact in adults and should be applied to adolescents to promote and sustain abstinence. Although pharmaceutical aids for cessation have been shown to be well tolerated and effective in adults, less is known about their use in adolescents. As such, clinicians are encouraged to explore whether pharmaceutical aids have been approved for use in adolescents in their country and to use discretion when considering their use in patients <18 years of age. Because pediatricians are in a unique position to facilitate tobacco cessation counseling, they should routinely ask their patients whether they use tobacco, advise users to quit, assess readiness to quit, assist with quitting, and arrange follow-up counseling. Tobacco cessation efforts can be enhanced by teaming with other health professionals (e.g. nurses, dentists, pharmacists, social workers) or worksite and community-based organizations that provide health promotion services.     

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.     

Ethnic differences in smoking withdrawal effects among adolescents

Smoking withdrawal effect information was collected from 75 adolescents (54 males and 21 females) making a quit attempt during a school-based smoking cessation program. A strong need to smoke was the most common withdrawal effect (60%), followed by irritability (51%), and difficulty concentrating (41%). Most (61%) participants experienced two or more withdrawal effects during the quit attempt, and withdrawal effects were evident in those smoking less than daily. Significant ethnic differences were found, with African Americans reporting significantly fewer withdrawal effects than Caucasians. After controlling for smoking frequency, African Americans were still less likely to report irritability, difficulty concentrating, and restlessness. Participants who chose to use nicotine replacement during the quit attempt were more likely to report difficulty concentrating, restlessness, and feeling miserable.     

Coping Mechanisms Actually and Hypothetically Used by Pregnant and Non-Pregnant Women in Quitting Smoking

ABSTRACT

The purpose of this article was to investigate how pregnant and non-pregnant women use various coping techniques when attempting to refrain from smoking. Eighty women with subgroups formed by the variables of pregnant/not pregnant and quitting/not quitting smoking were studied over a 2-week period. The general strategy was to follow smokers who had stated an intention to quit smoking. Smokers, pregnant and non-pregnant, who did not intend to quit were also followed with respect to the coping techniques they would hypothetically be using if they were trying to quit. Pregnant women used coping strategies more often than non-pregnant women. Differences found between pregnant and non-pregnant women were evenly distributed for behavioral and cognitive methods. The goal of becoming a non-smoker, especially during pregnancy, needs to be addressed to include psychological and physical factors. In these efforts, the framework introduced by the study involving a time-related approach could be useful.     

What Chinese Adolescents Think About Quitting Smoking: A Qualitative Study

The aim of this study was to investigate the attitudes of Chinese adolescents toward smoking, giving up smoking, and smoking cessation programs presently available. The study was a qualitative study carried out in 2002 by focus groups of 32 male secondary school students in Hong Kong who were either current smokers or had recently given up smoking. Subjects were students (grades 8–10) attending two full-day secondary schools in Hong Kong. Participants did not feel the need to make any serious psychological preparation for quitting. They underestimated the addictive nature of cigarette smoking and felt that they could choose to quit smoking at any time with little difficulty. Several barriers to quitting were reported, including boredom, peer influence, the urge to smoke, school work pressure, the wish to do something with their hands, difficulty in concentrating, and the ready availability of free cigarettes from peers. Those who had attempted to quit smoking (26/32) reported that peer influence and boredom were the main reasons why they started smoking and insisted that willpower and determination could have helped them in their quitting attempt. Participants were unanimous that pressure or encouragement from teachers, parents, or girlfriends did not help them to stay off cigarettes. Most (24/32) of the current smokers knew that smoking cessation services were available in Hong Kong, only 50% (12/24) of those who knew had made use of such services. None of the participants were able to identify any effective way of quitting smoking, though some suggested that the best practical measure was to avoid friends who smoked. The study suggests that attempts to persuade young people to quit smoking might benefit if they were framed to address issues such as the strong influence of their peers, the ease with which tobacco products can be obtained, the casual attitudes of young people toward smoking cessation, the perceived pros and cons of quitting, and (given that underage smoking is frowned upon by many parents and teachers) the need to respect confidentiality when offering support.     

Smoking behavior and interest in quitting among homeless smokers

OBJECTIVES: To examine smoking behavior in homeless persons, including the impact of self-reported tobacco-related health problems and drug and alcohol abuse on readiness to quit and interest in smoking cessation counseling. METHODS: Cross-sectional survey of outpatients and inpatients on the homeless service at Massachusetts General Hospital. RESULTS: Among 98 homeless smokers with a mean age of 44 years, tobacco-related medical diagnoses and symptoms and psychiatric illnesses were common, as were drug and alcohol abuse. One third of the smokers in this sample intended to quit smoking within the next 6 months, including 19% who planned to quit in the next 1 month. Forty-four percent of the participants were somewhat or very interested in smoking cessation counseling. In multivariate analyses, significant (P < .05) predictors of readiness to quit smoking were greater confidence in one's ability to quit (self-efficacy) and more social support for quitting. Multivariate predictors of interest in smoking cessation counseling were smoking-related symptoms and higher self-efficacy for quitting. CONCLUSIONS: Homeless smokers recruited from the inpatient and outpatient services of a large, urban teaching hospital reported interest in both stopping tobacco use and receiving assistance to quit smoking. Having an illness that a smoker believes is tobacco-related, having greater confidence in the ability to quit, and having more social support for quitting were associated with greater readiness to quit and more interest in smoking cessation counseling. Alcohol and drug abuse were not associated with reduced interest in quitting smoking. These findings suggest that homeless smokers may benefit from smoking cessation programs that are colocated in medical or drug treatment settings.     

What Chinese adolescents think about quitting smoking: a qualitative study

The aim of this study was to investigate the attitudes of Chinese adolescents toward smoking, giving up smoking, and smoking cessation programs presently available. The study was a qualitative study carried out in 2002 by focus groups of 32 male secondary school students in Hong Kong who were either current smokers or had recently given up smoking. Subjects were students (grades 8-10) attending two full-day secondary schools in Hong Kong. Participants did not feel the need to make any serious psychological preparation for quitting. They underestimated the addictive nature of cigarette smoking and felt that they could choose to quit smoking at any time with little difficulty. Several barriers to quitting were reported, including boredom, peer influence, the urge to smoke, school work pressure, the wish to do something with their hands, difficulty in concentrating, and the ready availability of free cigarettes from peers. Those who had attempted to quit smoking (26/32) reported that peer influence and boredom were the main reasons why they started smoking and insisted that willpower and determination could have helped them in their quitting attempt. Participants were unanimous that pressure or encouragement from teachers, parents, or girlfriends did not help them to stay off cigarettes. Most (24/32) of the current smokers knew that smoking cessation services were available in Hong Kong, only 50% (12/24) of those who knew had made use of such services. None of the participants were able to identify any effective way of quitting smoking, though some suggested that the best practical measure was to avoid friends who smoked. The study suggests that attempts to persuade young people to quit smoking might benefit if they were framed to address issues such as the strong influence of their peers, the ease with which tobacco products can be obtained, the casual attitudes of young people toward smoking cessation, the perceived pros and cons of quitting, and (given that underage smoking is frowned upon by many parents and teachers) the need to respect confidentiality when offering support.     

Relationship of perceived risks of smoking cessation to symptoms of withdrawal, craving, and depression during short-term smoking abstinence

The current study examined the relationship between perceived risks of quitting smoking and the self-reported experience of risks (e.g., cravings) during short-term abstinence. Participants (n=55) were daily smokers enrolled in a study of contingency management for smoking cessation with biochemically confirmed abstinence for 1 week. Participants were divided into groups of higher and lower perceived risk of quitting. There were no differences by risk group in demographics or baseline smoking, nicotine dependence, cravings, withdrawal, and depression. Although participants with higher levels of perceived risks reported a similar pattern of cravings and withdrawal symptoms during abstinence, they experienced higher levels of cravings, withdrawal symptoms, and depression than participants with lower risk beliefs. There were no differences in the relationship of risk to withdrawal symptoms by gender. Smokers with higher levels of perceived risk may find it more difficult to quit and remain abstinent due to higher levels of anticipated or experienced withdrawal symptoms and may benefit from targeted behavioral interventions with regard to risk perception and enhanced coping with withdrawal and other effects of smoking cessation.