Cognitive-behavioral treatment for depression in smoking cessation

Cigarette smokers with past major depressive disorder (MDD) received 8 group sessions of standard, cognitive-behavioral smoking cessation treatment (ST; n = 93) or standard, cognitive-behavioral smokiig cessation treatment plus cognitive-behavioral treatment for depression (CBT-D; n = 86). Although abstinence rates were high in both conditions (ST, 24.7%; CBT-D, 32.5%, at 1 year) for these nonpharmacological treatments, no main effect of treatment was found. However, secondary analyses revealed significant interactions between treatment condition and both recurrent depression history and heavy smoking ( > or =25 cigarettes a day) at baseline. Smokers with recurrent MDD and heavy smokers who received CBT-D were significantly more likely to be abstinent than those receiving ST (odds ratios = 2.3 and 2.6, respectively). Results suggest that CBT-D provides specific benefits for some, but not all, smokers with a history of MDD.     

Extended treatment with bupropion SR for cigarette smoking cessation

The authors present results of a randomized clinical trial of the efficacy of extended treatment with bupropion SR in producing longer term cigarette smoking cessation. Adult smokers (N = 362) received open-label treatment (11 weeks) that combined relapse prevention training, bupropion SR, and nicotine patch followed by extended treatment (14 weeks) with bupropion SR or matching placebo. Abstinence percentages were relatively high (week 11: 52%; week 25: bupropion, 42%; placebo, 38%; week 52: bupropion, 33%; placebo, 34%), but bupropion SR did not surpass placebo. Gender and baseline craving level were identified as significant, independent moderators of treatment response. Men were more likely to abstain than women (week 11: 59% vs. 43%, p = .001; week 25: 48% vs. 31%, p = .001; week 52: 39% vs. 27%, p = .01). Because most smokers suffer relapse with any current cessation treatment, the comparatively high abstinence percentages achieved in this trial are of interest.     

High-impact therapy for smoking cessation

Cigarette smoking is the leading cause of preventable death and disability-and thus an issue of considerable importance to psychotherapists. The majority of smoking-cessation programs available to the public uses an effective group format, but it remains underused. Many smokers who seek treatment request individual counseling; however, empirically based individual treatments are still in the early stages of development. High-impact therapy is a form of short-term dynamic psychotherapy adapted by the authors for the treatment of the hard-core smoker. It recognizes that the relationship among smoking, life stressors, personality factors, and psychological disorders is complex, and it intervenes using motivational and defense-challenging techniques. One of the main and distinctive features of this model is the emphasis on emotional arousal to facilitate the mastery of emotional conflict, making this a high-impact form of psychotherapy.     

Parental smoking cessation and adolescent smoking

OBJECTIVE: To examine the relation of parent smoking cessation to adolescent smoking and test its potential mediators. METHOD: Participants were 446 adolescents and their parents who completed a computerized measure of implicit attitudes toward smoking and questionnaires assessing smoking, parenting, and explicit attitudes. RESULTS: Parental smoking cessation was associated with less adolescent smoking, except when the other parent currently smoked. In general, ex-smoking parents showed more antismoking socialization than did smoking parents. However, in children's reports, these effects were negated if the other parent (particularly the mother) smoked. Children's reports of parents' antismoking behavior partially mediated the relation between parental smoking and adolescent smoking. Although children's implicit and explicit attitudes were unrelated to parental smoking, mothers' implicit attitudes were related to both their own smoking and their child's smoking. CONCLUSIONS: Parental smoking cessation may help lower risk for adolescent smoking. However, this benefit may be realized only if the other parent does not currently smoke. Antismoking parenting might be a useful focus in cessation interventions.     

Computerized smoking cessation program for the worksite: treatment outcome and feasibility

This study demonstrated the effectiveness of a computer-delivered smoking cessation program for the worksite. 58 VA Medical Center employees were randomly assigned to a computer group (computerized nicotine fading and stop-smoking contest) or a contest-only group. In comparison with the contest-only group, the computer group had nonsignificantly higher abstinence rates across follow-up, had marginally lower CO levels at the 3- and 6-month follow-ups, and smoked cigarettes with lower nicotine levels at the 10-day and 6-month follow-ups.     

Cost-effectiveness of varenicline and three different behavioral treatment formats for smoking cessation

There is a lack of evidence of the relative cost-effectiveness of proactive telephone counseling (PTC) and Web-based delivery of smoking cessation services in conjunction with pharmacotherapy. We calculated the differential cost-effectiveness of three behavioral smoking cessation modalities with varenicline treatment in a randomized trial of current smokers from a large health system. Eligible participants were randomized to one of three smoking cessation interventions: Web-based counseling (n=401), PTC (n=402), or combined PTC-Web counseling (n=399). All participants received a standard 12-week course of varenicline. The primary outcome was a 7-day point prevalent nonsmoking at the 6month follow-up. The Web intervention was the least expensive followed by the PTC and PTC-Web groups. Costs per additional 6-month nonsmoker and per additional lifetime quitter were $1,278 and $2,601 for Web, $1,472 and $2,995 for PTC, and $1,617 and $3,291 for PTC-Web. Cost per life-year (LY) and quality-adjusted life-year (QALY) saved were $1,148 and $1,136 for Web, $1,320 and $1,308 for PTC, and $1,450 and $1,437 for PTC-Web. Based on the cost per LY and QALY saved, these interventions are among the most cost-effective life-saving medical treatments. Web, PTC, and combined PTC-Web treatments were all highly cost-effective, with the Web treatment being marginally more cost-effective than the PTC or combined PTC-Web treatments.     

Internet-based smoking cessation programs

OBJECTIVE: To present a smoking cessation website and a reflection on the use of the Internet as a smoking cessation tool. METHODS: A literature review and an Internet survey in 1506 current and former smokers. RESULTS: The Internet may be the only form of smoking cessation support available to many smokers. There is a competition between hundreds of smoking cessation websites, many of which have a similar content. Smoking cessation websites are popular, but little scientific evidence is available on their efficacy. Neither do we know which components of these websites are most effective in motivating and helping smokers quit smoking and avoid relapse. Groups of current and former smokers form spontaneously in discussion forums on the Internet, this is a new feature in the field of addiction treatment. These discussion forums have not yet been the object of much scientific research. CONCLUSION: Research should be conducted to assess the efficacy of smoking cessation website, to identify which of their components are most effective, and to identify subgroups of current and former smokers for whom websites are most effective.     

Intrinsic and extrinsic motivation for smoking cessation

An intrinsic-extrinsic model of motivation for smoking cessation was evaluated with 2 samples (ns = 1.217 and 151) of smokers who requested self-help materials for smoking cessation. Exploratory and confirmatory principal components analysis on a 36-item Reasons for Quitting (RFQ) scale supported the intrinsic-extrinsic motivation distinction. A 4-factor model, with 2 intrinsic dimensions (concerns about health and desire for self-control) and 2 extrinsic dimensions (immediate reinforcement and social influence), was defined by 20 of the 36 RFQ items. The 20-item measure demonstrated moderate to high levels of internal consistency and convergent and discriminant validity. Logistic regression analyses indicated that smokers with higher levels of intrinsic relative to extrinsic motivation were more likely to achieve abstinence from smoking.     

Nicotine patch and paroxetine for smoking cessation

Smokers (N = 224) were randomized to 1 of 3 groups: (a) transdermal system (TNS) + placebo; (b) TNS + paroxetine (20 mg); (c) TNS + paroxetine (40 mg). Assignment to treatment was double-blind. Nicotine patch (TNS) treatment was provided for 8 weeks; paroxetine or placebo was provided for 9 weeks. Abstinence rates at Weeks 4, 10, and 26 were as follows: (a) TNS + placebo: 45%, 36%, and 25%; (b) TNS + paroxetine (20 mg): 48%, 33%, and 21%; (c) TNS + paroxetine (40 mg): 57%, 39%, and 27%. The differences were not statistically significant. The combined treatment was more effective in reducing both craving and depression symptoms associated with smoking cessation. A subgroup analysis comparing compliant participants was also conducted. Abstinence rates at Weeks 4, 10, and 26 were as follows: (a) TNS + placebo: 46%, 35%, and 24%; (b) TNS + paroxetine (20 mg): 64%, 43%, and 33%; (c) TNS + paroxetine (40 mg): 74%, 51%, and 38%. The differences between paroxetine groups and placebo at Week 4 were statistically significant. Although paroxetine may add value to the current standard of care in excess of potential risk, more conclusive evidence is needed.     

Intensified smoking cessation for diabetic patients--preliminary results

Cigarette smoking is the most prominent yet avoidable cause of illness in the general population as well as in patients with diabetes. The danger of developing late complications is much higher for smoking than for non-smoking diabetic patients. The aim of this study was to determine whether an intensified smoking cessation program for patients with diabetes, including an initial 3 week-period of inpatient cessation, is effective and more successful than a mere outpatient program. The outpatient program consisted of at least 7 consultations within 2 years, and included nicotine replacement therapy, steps for modifying the smokers' behavioural patterns, advice in dietary and exercise as well as measurements of amounts of exhaled carbonmonoxide and lung function. In the inpatient program the patients passed the first 3 cessation weeks in a specialised clinic providing a similar, but intensified program, aside from daily life and professional routine. The following consultations corresponded to those of the outpatient program. Altogether we analysed 89 patients (64 in the outpatient and 25 in the inpatient program).     

Efficacy of forced smoking cessation and an adjunctive behavioral treatment on long-term smoking rates

This study evaluated the efficacy of a 6-week forced ban on smoking and brief behavioral counseling on long-term smoking rates. Participants were active-duty enrollees in U.S. Air Force basic military training over a 1-year period (N = 25,996). All participants were under a 6-week ban from tobacco products, and 75% were randomized to a brief smoking cessation intervention, with the other 25% randomized to a control condition. At 1-year follow-up, 18% of smokers were abstinent; women, ethnic minorities, and those intending to stay quit at baseline were more likely to be abstinent. Among smokers not planning to remain abstinent at baseline, those receiving the intervention were 1.73 times more likely to be abstinent. Over time, substantial smoking initiation occurred among nonsmokers (8% of never smokers, 26% of experimental smokers, and 43% of ex-smokers). Forced cessation is associated with good levels of long-term cessation, and brief behavioral interventions enhance cessation in certain subgroups.     

An expert system intervention for smoking cessation

The Pathways to Change system (PTC) is an expert system intervention for smoking cessation. Assessments are performed either by mail or by a telephone interview and each smoker receives a three- to four-page report that provides individualized recommendations matched to the individual's needs and readiness-to-change. The Transtheoretical Model of Change provides the theoretical basis for the expert system. Four different studies have demonstrated the efficacy of this intervention in a general population, with cessation rates of 22 to 26%. Furthermore, the difference between the groups was larger at each follow-up assessment point, indicating that the effects of the treatment increased long after the end of treatment. The studies involved two proactively recruited samples, demonstrating that a large proportion (85.3% and 82.5%) of the population of smokers could be successfully recruited into a smoking cessation program. Expert system interventions have the potential to have an extremely high impact on a total population of smokers.     

A comparison of psychological and pharmacological treatment in smoking cessation

A double-blind trial of a smoking-withdrawal chewing gum containing 2 mg nicotine was conducted with 100 consecutive patients in a smoking cessation clinic. All patients received the usual psychological treatment given at the clinic. In addition, the patients were randomly assigned to a nicotine gum (the experimental group) or a placebo chewing gum (control group). The abstinence rates for the experimental group at 1, 3, and 6 months after quitting were 90, 76, and 63%, respectively. The comparable abstinence rates for the control group were 60, 52, and 45%. The differences were significant at the 5% level at all three follow-up periods. When nicotine dependence, as measured by a standard questionnaire, was taken into consideration, it was found that 71% of the high-nicotine-dependent smokers in the experimental group were abstinent after 6 months, as compared to 39% in the placebo group. In contrast, low-nicotine-dependent patients achieved 75 and 65%, respectively, for the same time interval. The gum was well accepted by patients and gave no serious side effects.     

Exercise as a smoking cessation treatment for women: a randomized controlled trial

Cigarette smoking remains the leading behavioral risk factor for chronic disease and premature mortality. This RCT tested the efficacy of moderate intensity aerobic exercise as an adjunctive smoking cessation treatment among women. Participants (N?=?105; age?=?42.5, SD?=?11.2) received brief smoking cessation counseling and 10 weeks of nicotine replacement therapy and were randomized to 12 weeks of moderate intensity exercise (Exercise; n?=?53) or 12 weeks of health education (Control; n?=?52). Longitudinal models, with Generalized Estimating Equations, showed no differences between Exercise and Control in cotinine-verified 7-day point prevalence abstinence (Wald?=?1.96, p?=?0.10) or continuous abstinence (Wald?=?1.45, p?=?0.23) at 12-weeks (post-treatment) or 6-, 9-, or 12-month follow-up, controlling for differences in baseline nicotine dependence. There was no effect of exercise on smoking cessation. The present study adds to the literature suggesting null effects of exercise as a smoking cessation adjunctive treatment despite promising findings in short-term laboratory based studies.

     

Predictors of adolescent smoking cessation and smoking reduction

Objective

To investigate the processes of change, demographic, health- and smoking-related predictors of both smoking cessation and smoking reduction in adolescents.

Methods

Data were drawn from a sample of 755 adolescent smokers who participated in a study testing the efficacy of a text messaging-based intervention for smoking cessation. Demographic, health- and smoking-related variables were assessed at baseline. Five processes of smoking cessation, derived from the Transtheoretical Model and the Social Cognitive Theory, as well as outcome measures were assessed at 6-month follow up. Univariate and multivariate regression analyses were conducted to identify baseline and process variables to predict smoking abstinence and smoking reduction.

Results

Male gender (OR = 0.43, p < .01), lower alcohol consumption (OR = 0.90, p = .05) and a lower number of cigarettes smoked per day at baseline (OR = 0.87, p < .01) predicted smoking abstinence. Baseline physical activity predicted smoking reduction (OR = 1.04, p = .03). None of the examined process variables significantly predicted smoking abstinence. The process variable “counter-conditioning” predicted smoking reduction (OR = 1.46, p = .03).

Conclusions

Baseline predictors of smoking cessation differ from predictors of smoking reduction. Dynamic or modifiable variables play an important role in predicting adolescent smoking cessation.

Practice implications

Counter-conditioning might be an important element in adolescent smoking cessation interventions.