Smoking cessation, weight gain, and DRD4 -521 genotype.

We investigated change in body mass index following long-term smoking cessation in a representative cohort of treatment-seeking heavy smokers in the United Kingdom, to determine the extent of long-term weight gain in successful quitters versus continuing smokers. We further investigated whether DRD4 genotype moderated any weight gain in either group. Smoking cessation was associated with an increase in BMI, and persisted up to 8 years after smoking cessation. Ex-smokers at 8-year follow-up weighed over 2.5 kg/m(3) more on average than they did at baseline, while participants who were smokers at both baseline and 8-year follow-up did not demonstrate any change in BMI. We did not observe an interaction between smoking status and DRD4 genotype. However, independently of the weight gain among those who stopped smoking during the course of the study, DRD4 genotype was significantly associated with BMI, with possession of the -521 C-allele associated with increased BMI. The magnitude of increase in BMI following smoking cessation, and the persistence of this change at 8-year follow-up, suggests that health benefits associated with smoking cessation may to some extent be negated by the detrimental effects on health of associated weight gain. Smoking cessation programmes should therefore consider incorporating follow-up support to promote weight loss among those who successfully stop smoking.     

A pilot community-based intensive smoking cessation intervention in African Americans: feasibility, acceptability and early outcome indicators

Few intensive and community-based smoking cessation treatment programs have been designed for African-American smokers, a group who experiences numerous health disparities associated with cigarette smoking. The purpose of this study was to examine the feasibility, acceptability and biochemically verified early outcome indicators in a community-based comprehensive smoking cessation program in 50 urban, low- and middle-income African-American smokers. The intervention was an intensive six-session group program delivered in the community and a one-month supply of the transdermal nicotine patch. Results showed 74% of enrolled participants completed the program and 51% of participants were highly adherent to patch use guidelines. Intent-to-treat analyses revealed that 34% of participants were biochemically confirmed as having quit smoking at one month post quit date. Smoking urges and depressive symptoms also declined significantly during the first month. At three- and six-month follow-up, biochemically confirmed quit rates were 22% and 18%, respectively. Adherence to nicotine patch use, higher ratings of the perceived helpfulness of self-monitoring tasks (wrap sheets) and lower depression scores at baseline all significantly predicted quitting success during the first month of treatment (all p's<0.05). Larger studies are warranted to examine targeted treatment elements and individual difference factors to enhance cessation outcomes in African-American smokers.     

Efficacy and cost-effectiveness of a clinic-based counseling intervention tested in an ethnically diverse sample of pregnant smokers

OBJECTIVE: Rates of cigarette smoking are higher among women who receive obstetric care through publicly funded prenatal clinics. This study compared smoking outcomes for pregnant women (n=105) who were randomized to receive either usual care (standard cessation advice from the health care provider) or an intervention conducted in the prenatal clinic consisting of 1.5 h of counseling plus telephone follow-up delivered by a masters prepared mental health counselor. METHODS: Subjects were 105 low income, predominantly Hispanic, pregnant patients in an urban prenatal clinic. Smoking outcomes were assessed at end of pregnancy and 6 months post-partum. RESULTS: At follow-up, 28.3% and 9.4% of participants in the experimental intervention and 9.6% and 3.8% of patients in usual care were abstinent at end of pregnancy (p=.015) and 6 months post-partum, respectively (p=.251). Cost of the intervention was $56 per patient and cost to produce a non-smoker at end of pregnancy was $299. CONCLUSIONS: This model for intervention was cost-effective and was associated with significantly lower smoking rates at end of pregnancy. PRACTICAL IMPLICATIONS: If these findings are replicated, prenatal clinics could offer the option for intensive smoking cessation treatment by training mental health counselors to deliver one extended smoking cessation counseling session.     

Effectiveness of a telephone delivered and a face-to-face delivered counseling intervention for smoking cessation in patients with coronary heart disease: a 6-month follow-up

Smoking cessation interventions for cardiac patients need improvement given their weak effects on long-term abstinence rates and low compliance by nurses to implementation. This study tested the effectiveness of two smoking cessation interventions against usual care in cardiac patients, and conditional effects for patients’ motivation to quit and socio-economic status (SES). An experimental study was conducted from 2009 to 2012 for which Dutch cardiac patient smokers were assigned to: usual care (UC; n = 245), telephone counseling (TC; n = 223) or face-to-face counseling (FC; n = 157). The three groups were comparable at baseline and had smoked on average 21 cigarettes a day before hospitalization. After six months, interviews occurred to assess self-reported smoking status. Patients in the TC and FC group had significantly higher smoking abstinence rates than patients in the UC group (p ≤ 0.05 at all times). Regression analysis further revealed significant conditional effects of the interventions on smoking abstinence in patients with lower SES, with a larger effect for TC than FC when compared to UC. These findings suggest that intensive counseling is effective in increasing short-term abstinence rates, particularly in patients with lower SES. Future studies need to investigate how patients with higher SES can profit equally from these type of interventions.     

A review of smoking cessation interventions for smokers aged 50 and older

Objectives

Cigarette smoking poses substantial health risks at any age, but is particularly dangerous for older smokers, who are already at heightened risk for various health conditions. Studies suggest that older smokers are motivated to quit and succeed, but few of these have been randomized controlled trials. There is a need to systematically evaluate the research on effective interventions in older smokers.

Methods

We followed PRISMA guidelines in the development of this systematic review, which included randomized controlled trials of cessation interventions with smokers aged 50 or older.

Results

We found 740 unique titles matching specified search criteria; 13 met final eligibility criteria. Nearly all the cessation treatments combined counseling with other strategies. Eight studies provided smoking cessation medications. None of the studies used newer forms of technology such as web- or text-based interventions. Nine of the 13 studies reported a significant intervention effect at one or more time points, with three studies reporting sustained treatment effects at 12 mos or longer. In general, more intensive interventions and those with combined approaches including medications and follow-up counseling achieved the best outcomes.

Conclusion

The quit rates from these studies and the relative effectiveness of different intervention approaches are consistent with the general smoking cessation literature. However, in most studies, treatment effects were of short duration, and absolute quit rates were low, leaving the vast majority of older smokers at high risk for smoking-related health conditions. This systematic review suggests a need for additional research to design and test future interventions specifically tailored for older smokers.     

Multicenter trial of fluoxetine as an adjunct to behavioral smoking cessation treatment

The authors evaluated the efficacy of fluoxetine hydrochloride (Prozac; Eli Lilly and Company, Indianapolis, IN) as an adjunct to behavioral treatment for smoking cessation. Sixteen sites randomized 989 smokers to 3 dose conditions: 10 weeks of placebo, 30 mg, or 60 mg fluoxetine per day. Smokers received 9 sessions of individualized cognitive-behavioral therapy, and biologically verified 7-day self-reported abstinence follow-ups were conducted at 1, 3, and 6 months posttreatment. Analyses assuming missing data counted as smoking observed no treatment difference in outcomes. Pattern-mixture analysis that estimates treatment effects in the presence of missing data observed enhanced quit rates associated with both the 60-mg and 30-mg doses. Results support a modest, short-term effect of fluoxetine on smoking cessation and consideration of alternative models for handling missing data.     

A controlled smoking cessation trial for substance-dependent inpatients

Smoking treatment for newly recovering drug and alcohol-dependent smokers in a residential rehabilitation program was examined. The randomly assigned conditions (n = 50 each) were multicomponent smoking treatment (MST), MST plus generalization training of smoking cessation to drug and alcohol cessation (MST+G), or usual care (UC). Fifty participants who declined smoking treatment (treatment refusers) also were studied. Both treatment conditions achieved continuous smoking abstinence rates (MST: 12%, MST+G: 10%, at 12-month follow-up) that were significantly higher than in the UC condition (0%). The MST condition had a continuous drug and alcohol abstinence rate that was significantly higher than that of the MST+G condition (40% vs. 20% at 12-month follow-up) although neither differed significantly from that of the UC condition (33%). These results support the feasibility of smoking treatment for this population and provide information regarding appropriate treatment components.     

"I did it my way"--an explorative study of the smoking cessation process among Danish youth

Objective

To explore the smoking cessation process of adolescents and their attitudes and beliefs towards smoking cessation and cessation interventions.

Method

Focus group discussions and individual interviews during April–May 2004 with 26 persons aged 15–21 years who all initiated a quit attempt on 1 January 2004.

Results

The approach towards all stages of the youth smoking cessation process varied greatly among both successful and unsuccessful quitters. Apart from ‘commitment’ or the amount of energy put into a cessation attempt, there were no differences in the way successful and unsuccessful quitters approached the quit attempt. ‘Smoking friends’ and ‘social support’ were important for maintaining cessation. Further, participants had negative attitudes towards formalized smoking cessation interventions.

Conclusion

There are many approaches to the smoking cessation process. Whether an attempt is successful depends more on individual conditions and the amount of commitment invested in the attempt than on the specific cessation strategy used.

Practice Implications

Future adolescent smoking cessation interventions should be flexible regarding both structure and content and should focus on the individual learning process, rather than adhering to rigid cessation strategies.     

Comparing Two Web-Based Smoking Cessation Programs: Randomized Controlled Trial

Background

Smoking cessation remains a significant public health problem. Innovative interventions that use the Internet have begun to emerge that offer great promise in reaching large numbers of participants and encouraging widespread behavior change. To date, the relatively few controlled trials of Web-based smoking cessation programs have been limited by short follow-up intervals.

Objective

We describe the 6-month follow-up results of a randomized controlled trial in which participants recruited online were randomly assigned to either a Web-based smoking cessation program (Quit Smoking Network; QSN) or a Web-based exercise enhancement program (Active Lives) adapted somewhat to encourage smoking cessation.

Methods

The study was a two-arm randomized controlled trial that compared two Web-based smoking cessation programs: (1) the QSN intervention condition presented cognitive-behavioral strategies, and (2) the Active Lives control condition provided participants with guidance in developing a physical activity program to assist them with quitting. The QSN condition provided smoking cessation information and behavior change strategies while the Active Lives condition provided participants with physical activity recommendations and goal setting. The QSN condition was designed to be more engaging (eg, it included multimedia components) and to present much greater content than is typically found in smoking cessation programs.

Results

Contrary to our hypotheses, no between-condition differences in smoking abstinence were found at 3- and 6-month follow-up assessments. While participants in the QSN intervention condition spent more time than controls visiting the online program, the median number of 1.0 visit in each condition and the substantial attrition (60.8% at the 6-month follow-up) indicate that participants were not as engaged as we had expected.

Conclusions

Contrary to our hypothesis, our test of two Web-based smoking cessation conditions, an intervention and an attention placebo control, failed to show differences at 3- and 6-month assessments. We explored possible reasons for this finding, including limited engagement of participants and simplifying program content and architecture. Future research needs to address methods to improve participant engagement in online smoking cessation programs. Possible approaches in this regard can include new informed consent procedures that better explain the roles and responsibilities of being a research participant, new program designs that add more vitality (changing content from visit to visit), and new types of reminders pushed out to participants to encourage return visits. Simplifying program content through a combination of enhanced tailoring and information architecture also merits further research attention.     

Are digital interventions for smoking cessation in pregnancy effective? A systematic review and meta-analysis

ABSTRACT

Smoking in pregnancy remains a global public health issue due to foetal health risks and potential maternal complications. The aims of this systematic review and meta-analysis were to explore: (1) whether digital interventions for pregnancy smoking cessation are effective, (2) the impact of intervention platform on smoking cessation, (3) the associations between specific Behaviour Change Techniques (BCTs) delivered within interventions and smoking cessation and (4) the association between the total number of BCTs delivered and smoking cessation. Systematic searches of 9 databases resulted in the inclusion of 12 published articles (n?=?2970). The primary meta-analysis produced a sample-weighted odds ratio (OR) of 1.44 (95% CI 1.04–2.00, p?=?.03) in favour of digital interventions compared with comparison groups. Computer-based (OR?=?3.06, 95% CI 1.28–7.33) and text-message interventions (OR?=?1.59, 95% CI 1.07–2.38) were the most effective digital platform. Moderator analyses revealed seven BCTs associated with smoking cessation: information about antecedents; action planning; problem solving; goal setting (behaviour); review behaviour goals; social support (unspecified); and pros and cons. A meta-regression suggested that interventions using larger numbers of BCTs produced the greatest effects. This paper highlights the potential for digital interventions to improve rates of smoking cessation in pregnancy.     

Efficacy and cost-effectiveness of a clinic-based counseling intervention tested in an ethnically diverse sample of pregnant smokers

ObjectiveRates of cigarette smoking are higher among women who receive obstetric care through publicly funded prenatal clinics. This study compared smoking outcomes for pregnant women (n = 105) who were randomized to receive either usual care (standard cessation advice from the health care provider) or an intervention conducted in the prenatal clinic consisting of 1.5 h of counseling plus telephone follow-up delivered by a masters prepared mental health counselor.MethodsSubjects were 105 low income, predominantly Hispanic, pregnant patients in an urban prenatal clinic. Smoking outcomes were assessed at end of pregnancy and 6 months post-partum.ResultsAt follow-up, 28.3% and 9.4% of participants in the experimental intervention and 9.6% and 3.8% of patients in usual care were abstinent at end of pregnancy (p = .015) and 6 months post-partum, respectively (p = .251). Cost of the intervention was $56 per patient and cost to produce a non-smoker at end of pregnancy was $299.ConclusionsThis model for intervention was cost-effective and was associated with significantly lower smoking rates at end of pregnancy.Practical implicationsIf these findings are replicated, prenatal clinics could offer the option for intensive smoking cessation treatment by training mental health counselors to deliver one extended smoking cessation counseling session.     

Addressing tobacco use disorder in smokers in early remission from alcohol dependence: The case for integrating smoking cessation services in substance use disorder treatment programs

Despite the declining overall rate of cigarette smoking in the general population in the United States, the prevalence of smoking is estimated to be as high as 80% among treatment-seeking alcoholics. The serious adverse health effects of tobacco and heavy alcohol use are synergistic and recent evidence suggests that smoking slows the process of cognitive recovery following alcohol abstinence. In addition, substantial evidence shows that treatment for tobacco dependence does not jeopardize alcohol abstinence. In this paper, we focus on the impact and treatment implications of tobacco dependence among treatment-seeking alcoholics through a review of five areas of research. We begin with brief reviews of two areas of research: studies investigating the genetic and neurobiological vulnerability of comorbid tobacco and alcohol dependence and studies investigating the consequences of comorbid dependence on neurobiological and cognitive functioning. We then review literature on the effects of smoking cessation on drinking urges and alcohol use and the effectiveness of smoking cessation interventions with alcoholic smokers. Finally, we offer recommendations for research with an emphasis on clinical research for enhancing smoking cessation outcomes in this population.     

Alcoholics anonymous and relapse prevention as maintenance strategies after conjoint behavioral alcohol treatment for men: 18-month outcomes

Ninety men with alcohol problems and their female partners were randomly assigned to 1 of 3 outpatient conjoint treatments: alcohol behavioral couples therapy (ABCT), ABCT with relapse prevention techniques (RP/ABCT), or ABCT with interventions encouraging Alcoholics Anonymous (AA) involvement (AA/ABCT). Couples were followed for 18 months after treatment. Across the 3 treatments, drinkers who provided follow-up data maintained abstinence on almost 80% of days during follow-up, with no differences in drinking or marital happiness outcomes between groups. AA/ABCT participants attended AA meetings more often than ABCT or RP/ABCT participants, and their drinking outcomes were more strongly related to concurrent AA attendance. For the entire sample, AA attendance was positively related to abstinence during follow-up in both concurrent and time-lagged analyses. In the RP/ABCT treatment, attendance at posttreatment booster sessions was related to posttreatment abstinence. Across treatment conditions, marital happiness was related positively to abstinence in concurrent but not time-lagged analyses.     

Effectiveness of proactive Quitline service and predictors of successful smoking cessation: findings from a preliminary study of Quitline service for smoking cessation in Korea

This study was to evaluate the effectiveness of the first proactive Quitline service for smoking cessation in Korea and determine the predictors of successful smoking cessation. Smoking participants were voluntarily recruited from 18 community health centers. The participants were proactively counseled for smoking cessation via 7 sessions conducted for 30 days from November 1, 2005 to January 31, 2006. Of the 649 smoking participants, 522 completed 30 days at the end of the study and were included in the final analysis. The continuous abstinence rate at 30 days of follow-up was found to be 38.3% (200/522), in the intention-to-treat analysis. Compared with non-quitters, quitters were mostly male, smoked <20 cigarettes/day, had started smoking at the age of >or=20 yr, and were less dependent on nicotine. Based on the stepwise multiple logistic regression analysis, the significant predictors of successful smoking cessation were determined to be male sex, low cigarette consumption, and older age at smoking initiation. We investigated the short-term effectiveness of the Quitline service and determined the predictors of successful smoking cessation.     

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.     

Modulation of the endogenous Annexin A1 in a cigarette smoke cessation model: Potential therapeutic target in reversing the damage caused by smoking?

BackgroundSmoking cessation may help in the reversal of inflammation and damage caused by smoking. The endogenous annexin A1 (AnxA1) protein has anti-inflammatory effects which instigates the understanding of its role in the attenuation of inflammatory processes caused by smoking.Material and methodsWistar rats were exposed to cigarette smoke for 8 weeks. After the exposure period, one of the groups remained other 8 weeks in the absence of smoke. Animals not exposed to smoke were used as control. Blood, trachea and lungs were obtained for histopathological, immunohistochemical and biochemical analyses.ResultsLoss of cilia of the tracheal lining epithelium was found by smoke exposure, but smoking cessation led to recovery of the tracheal epithelium. Similarly, chronically exposed-to-smoke animals showed increased lymphocytes and macrophages in bronchoalveolar lavage and higher levels of glucose and gamma-GT in their blood. Reduction of lymphocytes, glucose and gamma-GT occurred after smoking cessation. In addition, IL-1β, IL-6, IL-10, TNF-α and MCP-1 levels were elevated by smoke exposure. Smoking cessation significantly reduced the levels of IL-1β, IL-6 and MCP-1 but increased the IL-10 concentration. Numerous mast cells and macrophages were observed in the lung of chronically exposed-to-smoke animals with reduction by smoking cigarette abstinence. AnxA1 increased expression and concomitant NF-κB reduction were found in the smoking cessation group.ConclusionOur results showed that cigarette abstinence promoted partial recovery of the inflammatory process. The attenuation of the inflammatory profile may be associated with the overexpression of AnxA1 protein.     

Barriers to quitting smoking among medically ill smokers

Few studies examine predictors of smoking cessation among medically ill smokers, despite their high smoking prevalence. We prospectively examined barriers to smoking cessation in medically ill smokers, with age as a hypothesized moderator. Participants were smokers (N = 237, M (age) = 56.1, 53.6% females) receiving home-based nursing care. Baseline self-report questionnaires assessed barriers to cessation (demographics, smoking history, psychosocial, and medical factors). Smoking status was biochemically verified at 2- and 6-months post-intervention. Compared with younger smokers, older smokers had significantly lower levels of nicotine dependence, stress, and depressed mood and a greater prevalence of smoking-related diseases. Older smokers were more likely to achieve biochemically verified abstinence at 6-month follow-up (7.8%) than younger smokers (3.1%) though this difference was not significant. Higher levels of depressed mood and lower levels of perceived stress were associated with a greater likelihood of cessation at both follow-up points, but only for younger smokers. For younger smokers, higher self-efficacy to quit and the presence of a smoking-related disease increased the odds of abstinence. These findings could help guide treatment development for this high-risk group of smokers.     

Addressing heavy drinking in smoking cessation treatment: a randomized clinical trial

Heavy alcohol use frequently co-occurs with cigarette smoking and may impede smoking cessation. This clinical trial examined whether smoking cessation treatment that incorporates brief alcohol intervention can improve smoking cessation outcomes (7-day verified point prevalence abstinence) and reduce drinks consumed per week. Heavy drinkers seeking smoking cessation treatment were assigned by urn randomization to receive, along with 8 weeks of nicotine replacement therapy, either a 4-session standard smoking cessation treatment (ST, n = 119) or standard treatment of equal intensity that incorporated brief alcohol intervention (ST-BI, n = 117). Across follow-ups over 26 weeks, participants in ST-BI reported approximately 20% fewer drinks per week (p < .027) and greater smoking abstinence (adjusted odds ratio = 1.56; 95% confidence interval = 1.01, 2.43) than did those in ST; however, effects on smoking were primarily evident at 2 weeks after quit date and were essentially absent by 16 weeks. The effect of ST-BI on smoking outcome was most robust among moderately heavy drinkers compared with that on very heavy drinkers. Integrating brief alcohol intervention into smoking cessation treatment appears feasible, but further development is needed to yield lasting effects on smoking.     

Comorbidity, smoking behavior and treatment outcome

BACKGROUND: A sizeable sector of the population continues to smoke cigarettes despite our efforts to prevent and treat this addiction. We explored the relationships between lifetime comorbidity, psychiatric symptomatology, smoking behavior and treatment outcome to better understand vulnerability to smoking and treatment response. METHODS: One hundred and twenty smokers at two sites were enrolled in a multicenter, double-blind, randomized, 10-week smoking cessation trial with fluoxetine and behavioral treatment. The Structured Clinical Interview for DSM-III-R and Hamilton Depression Rating Scale were administered prior to treatment initiation. Self-report measures were used to assess psychiatric symptoms throughout treatment and during a 6-month follow-up period. RESULTS: Overall 62.3% of our sample were diagnosed with a lifetime mood, anxiety or substance use disorder despite stringent study exclusion criteria. Lifetime comorbidity was shown to be related to higher smoking rates and nicotine dependence, depressed mood and greater self-report of anxiety and stress. Lifetime comorbidity, however, alone or in combination with treatment condition, failed to predict treatment outcome (at posttreatment or follow-up). Baseline depression scores (Beck Depression Inventory, BDI) were related to treatment outcome only for smokers without a positive history of any psychiatric disorder or depression, with lower BDI scores more frequent in those who were abstinent. CONCLUSIONS: High prevalence rates of lifetime psychiatric illness and substance use disorders are reported for chronic smokers. Subsyndromal psychiatric symptoms may play a role in smoking behavior in combination with diagnosable disorders. Clinicians need to carefully assess both psychiatric diagnoses and symptoms in chronic smokers to optimize patient-treatment matching.     

Tryptophan and high-carbohydrate diets as adjuncts to smoking cessation therapy

Treatments that reduce the immediate effects of smoking withdrawal have potential for helping smokers quit. Serotonin-enhancing substances, such as tryptophan and high-carbohydrate diets, have been used in clinical disorders to relieve negative affect, a classic symptom of cigarette withdrawal. This research project investigated the use of tryptophan (50 mg/kg/day) and high-carbohydrate diets, together with more traditional smoking cessation treatment techniques, to ameliorate the smoking withdrawal syndrome and to improve abstinence rates. Subjects were randomly assigned to receive either tryptophan (n=16) or placebo (n=15). Standard smoking cessation treatment was identical for the experimental and control groups and consisted of four 2-hr weekly sessions of multicomponent group therapy. Smoking behavior, symptoms of nicotine withdrawal, and negative affect were assessed during a 2-week withdrawal period. Tryptophan-treated subjects who could not fully abstain were able to smoke fewer daily cigarettes. Reported anxiety and other withdrawal symptoms were lower in the tryptophan group compared with control subjects. These data suggest that serotonin-enhancing substances show promise for use as an adjunct to existing smoking cessation programs.