Feasibility of computerized scheduled gradual reduction for adolescent smoking cessation

The purpose of this project was to modify a smoking cessation program that uses computerized scheduled gradual reduction for use with adolescent smokers and to test the feasibility of this cessation approach in group support and minimal contact modalities. Utilizing a lesson plan approach with high school marketing students in five high schools and student survey feedback, the LifeSign program was modified to be an acceptable smoking cessation program for adolescent smokers. In the first study, 17 adolescent smokers used the modified program with seven associated weekly group support sessions. At the end of treatment, 29% had quit smoking, and over half of those who continued to smoke reduced their smoking rate by 50%. In the second study, the LifeSign for Teens program was evaluated with 18 adolescent smokers in a minimal contact format. At the end of treatment, 17% had quit smoking, and mean smoking rate reductions of 43% were found among those who continued smoking. At 1-year follow-up, all subjects who had quit at posttreatment reported continuous abstinence. The results of these two small trials suggest that a computerized scheduled gradual reduction approach may be an accepted and potentially efficacious approach for smoking cessation among adolescent smokers.     

Stress management training as a prevention program for heavy social drinkers: cognitions, affect, drinking, and individual differences

The effectiveness of cognitive-affective stress management training (SMT) as a drinking reduction program for heavy social drinking college students was investigated. The SMT package included muscle relaxation and meditation training, cognitive restructuring, and coping skill rehearsal during induced affect. Treated and control subjects rated the frequency and intensity of their anxiety, anger and depression and recorded their alcohol consumption on a daily basis over a 6-month period. SMT significantly reduced posttreatment daily anxiety ratings and was associated with changes in four of ten irrational beliefs and a shift toward more internal locus of control in treated subjects. Reduction in anxiety was no longer evident at the 2 1/2- and 5 1/2-month follow-ups. The men in the SMT group showed a significant decrease in daily drinking rates at posttreatment and at the 2 1/2-month follow-up, but drinking returned to baseline levels by 5 1/2 months for the group as a whole. However, significant improvement variance in daily moods and in drinking rates over all posttreatment periods was accounted for by individual difference variables in the trained subjects but not in the control group, suggesting that these cognitive, personality, and social support variables are associated with response to stress management training. Implications of these results for future prevention research are discussed.     

Long-term follow-up (3–4 years) of treatment for smoking reduction

The present paper reports the 3- and 4-year follow-ups of two smoking reduction clinics (n = 103) employing a comprehensive, non-aversive, behavioral treatment using stimulus control and self-control techniques. Most of the data were gathered via phone contact, while some clients were interviewed in person with corroborative carbon monoxide measurements taken at that time. While the general findings were similar to those reported for other long-term follow-ups of smoking programs, unlike earlier-reports, the overwhelming majority of subjects were contacted (an average of 90% for all follow-up periods). The average percentage of baseline for smoking subjects was equal to 56% and average percentage abstinent equal to 24% at final follow-up. Data are also presented which suggest greater attention be paid to the potential efficacy of controlled smoking when assessing the effectiveness of smoking reduction programs.     

A 12-week double-blind, placebo-controlled study of bupropion sr added to high-dose dual nicotine replacement therapy for smoking cessation or reduction in schizophrenia

The objective of this study was to examine whether there is a benefit of adding bupropion SR to high-dose combination nicotine replacement therapy (NRT) and weekly group cognitive behavioral therapy (CBT) for smoking reduction or cessation in schizophrenia. Fifty-one adult smokers with schizophrenia were randomly assigned to a 12-week trial of bupropion SR 300 mg/d or placebo added to transdermal nicotine patch, nicotine polacrilex gum, and CBT. The treatment goal was smoking cessation. The primary outcome measure was biochemically confirmed 7-day point-prevalence of 50% to 100% smoking reduction at week 12. Secondary outcomes were biochemically confirmed tobacco abstinence and change from baseline in expired air carbon monoxide (CO) and psychiatric symptoms. Subjects on bupropion + NRT had a greater rate of 50% to 100% smoking reduction at weeks 12 (60% vs. 31%; P = 0.036) and 24, a lower expired air CO in the treatment and follow-up periods, (F = 13.8; P < 0.001) and a greater continuous abstinence rate at week 8, before NRT taper, (52% vs. 19%; P = 0.014). However, relapse rates in subjects on bupropion + dual NRT were 31% during NRT taper (weeks 8-12) and 77% at the 12-month follow-up. Abstinence rates did not differ by treatment group at weeks 12 (36% vs. 19%), 24 (20% vs. 8%), or 52 (12% vs. 8%). Because abstinence rates were high during treatment with combination pharmacotherapy and relapse rates were very high during taper and after discontinuation of treatment, study of longer term treatment with combination pharmacotherapy and CBT for sustained abstinence is warranted in those who attain initial abstinence with this intervention.     

Controlled smoking: Development and maintenance

This study investigated the development and maintenance of controlled smoking (smoking at or below a target rate set by the individual smoker). Two procedures, Programmed Delay and Contingency Contracting, were compared with 16 smokers. Each group served as its own control using a multiple baseline design across subjects. Contingency contracting resulted in less attrition and the more frequent development and maintenance of controlled smoking. Subjects reported using the treatment procedures only occasionally during follow-up. Considerations for further research into controlled smoking are discussed.     

Project EX--a teen smoking cessation initial study in Wuhan, China

The increasing smoking prevalence in China indicates a need for effective smoking cessation programs, yet, to our knowledge, no studies have evaluated the effects of smoking cessation programs among Chinese adolescents. A group of 46 10th-grade-level cigarette smokers from two schools in Wuhan, China, were provided with Project EX, an eight-session school-based clinic smoking cessation program developed in the United States. Efforts of translation of the Project EX curriculum, verification of translation, curriculum modification, and cultural adaptation were made to adapt the curriculum to the local culture. The 46 smokers represented 71% of all the self-reported 30-day smokers among 622 10th graders at these two schools. Only one student dropped out from the clinic program. Four-month follow-up data indicated a 10.5% 30-day quit rate and a 14.3% 7-day quit rate. The students who did not quit smoking reported a 16% reduction in daily cigarette consumption at posttest and a 33% reduction at 4-month follow-up. Use of a 2 1/2-week prebaseline-to-baseline clinic assessment indicated a clinic cohort nonassisted quit rate of 3%. These data provided evidence that Project EX can be adapted in another country, such as China; can be very well received; and can lead to promising results on cessation.     

Immediate and six-month effects of Project EX Russia: A smoking cessation intervention pilot program

This study evaluates the performance of the Project EX tobacco use cessation program in Russian summer recreational camps. An eight-session clinic-based tobacco use cessation program for adolescents was tested during the summer of 2011 in an experimental pilot trial that involved different youth that rotated through camps. Conditions were nested within camps. Two rotations of unique subject groups of smokers (program and standard care control) through each of five camps provided the means of controlling for campsite by condition. Assignment of condition by rotation was random (by a flip of a coin), achieving reasonable baseline comparability (total n = 164 smokers at baseline, 76 program group, 88 standard care control group). Evaluation involved an immediate pretest and posttest and a six-month telephone follow-up. At immediate posttest, Project EX was moderately well-received, significantly reduced future smoking expectation (46% reduction in EX program condition versus 8% in control, p < .0001), decreased intention to not quit smoking (− 5.2% in EX versus + 1.4% in control, p < .05), and increased motivation to quit smoking (0.72 versus − 0.04, p < .0001). At the six-month follow-up, program subjects reported a higher intent-to-treat quit rate during the last 30 days (7.5% versus 0.1%, p < .05). For the subjects who remained monthly smokers at the six-month follow-up, Project EX reduced subjects' level of nicotine dependence (− 0.53 versus + 0.15, p < .001). The results were quite promising for this program, which included motivation enhancement, coping skill, and alternative medicine material. However, further research on teen tobacco use cessation programming in Russia with larger sample sizes, involving other locations of the country, and with stronger research designs is needed.     

Controlled smoking for chronic smokers: an extension and replication

Nine long-term cigarette smokers participated in a seven session controlled smoking program. Employing a multiple baseline across behaviors design, the program focused on making sequential reductions in nicotine content of the cigarette brand smoked, percent of each cigarette smoked and, finally, number of cigarettes smoked per day. Self-monitoring records indicated that subjects were successful in making reductions in each of the three target behaviors and that the timing of these changes closely followed the initiation of treatment for each specific behavior. The magnitude of change was greatest for nicotine content (49% reduction) and somewhat less for number of cigarettes (28% reduction) and amount smoked (24% reduction). Carbon monoxide levels were also reduced and these reductions, as well as the smoking behavior changes, were generally maintained at a 6-month follow-up. This study provides a systematic replication of an earlier study and illustrates the usefulness of single subject designs for studying cigarette smoking. It is concluded that controlled smoking can be achieved by chronic smokers without significant relapse or compensation for at least six months following treatment. Limitations of the study and directions for future research are also discussed.     

A Comprehensive Worksite Smoking Control,Discouragement, and Cessation Program

The effectiveness of a comprehensive program of worksite smoking control, discouragement, and cessation was compared with a program of smoking cessation alone. Two comparable oil refineries served as the research sites. Outcome variables consisted of employee self-reported smoking rate assessed by the use of a smoking questionnaire and unobtrusive observations of smoking behavior before and after the intervention. One company was randomly assigned to the comprehensive program of smoking control, discouragement, and cessation while the other company only received smoking cessation. Humorous antismoking posters emphasizing the benefits of quitting smoking were distributed throughout the first worksite and changed every 2 weeks. Large banners stating “Go SmokeFree” were also placed at all locations to this plant and left up for the duration of the study. Three weeks after the initiation of the smoking discouragement program at one refinery, a group smoking cessation program was begun at both plants. At a 5-month follow-up, participants in the smoking cessation treatment at the plant receiving the comprehensive program achieved a 5-month abstinence rate of 43% in comparison with a rate of 21% at the refinery receiving only smoking cessation.     

Implications of self-monitoring for smoking treatment: Effects on adherence and session attendance

The reactive effects of three self-monitoring procedures were evaluated with respect to compliance with the self-monitoring requirements and session attendance. A total of 50 smokers who agreed to participate in a smoking cessation program were randomly assigned to one of five conditions: three self-monitoring conditions and two no self-monitoring control conditions. Results indicate that groups were initially equal on the variables of age, sex, pack year history, estimated rate of consumption, and alveolar carbon monoxide level. Drop-out rates for the no self-monitoring control groups were equal at the second session (10% each) and significantly lower than those of the self-monitoring groups (40%, 40%, and 60%). This significant differences was still present at the sixth treatment session. The implications of increased drop-out rates in smoking cessation programs resulting from self-monitoring are discussed.     

Six-month and one-year effects of project EX-4: a classroom-based smoking prevention and cessation intervention program

OBJECTIVE: This study evaluated the efficacy of a version of Project EX that was adapted for implementation in the classroom context (Project EX-4). This paper reports the program outcomes based on pretest, six-month, and one-year follow-up surveys. METHODS: An 8 session classroom-based curriculum was tested with a clustered randomized controlled trial that involved a total of 1097 students in 6 program and 6 control alternative high schools. Weekly and monthly smoking was assessed at the three time points. Outcome effects were analyzed with multi-level random coefficients models. RESULTS: Students in the program condition experienced a greater reduction in weekly smoking and monthly smoking, at 6-and-12-month follow-ups. The net change varied between -5.1% and -7.6%, comparing the program condition to the control condition. CONCLUSIONS: The implementation of Project EX in a classroom setting produced decreases in smoking among students in the program, relative to those in the standard care control condition. It is likely that a classroom-based smoking prevention/cessation program can lead to lower overall smoking prevalence than a cessation program that is implemented in a school-based smoking cessation clinic format.     

Effectiveness of telephone contact as an adjunct to a self-help program for smoking cessation: a randomized controlled trial in Spanish smokers.

This study evaluated the effect of telephone counseling as an adjunct to a self-help program for smoking cessation conducted through the mail. We obtained demographic and consumption information on those smokers who requested participation in the study. These participants (N = 200) were randomized into two study groups: (1) the standard self-help group (n = 100) (median age: 35.1 years; pretreatment consumption of 28.0 cigarettes/day); (2) the self-help group receiving additional multiple-contact telephone counseling (n = 100) (median age: 36.7 years; pretreatment consumption of 27.3 cigarettes/day). At the 12-month follow-up, the carbon monoxide in expired air was used to distinguish nonsmokers from smokers. Significant differences were found in the rates of continuous abstinence in both groups for each period evaluated. In the standard self-help group, the continuous abstinence rate at the 3-month follow-up was 21%, 18% at the 6-month follow-up, and 14% at the 12-month follow-up. The telephone counseling group yielded a 48% continuous abstinence rate at the 3-month follow-up, 40% at the 6-month follow-up, and 27% at the 12-month follow-up. The results of this randomized controlled trial show that telephone counseling was an effective aid for the smoking cessation program.     

A minimal contact smoking cessation program at the worksite

This article describes a minimal contact, broad-spectrum behavioral smoking cessation program conducted at the worksite. At 6-month follow-up, the abstinence rate was equivalent to most similar interventions, but with a surprisingly robust 50% maintenance rate for those who succeeded in quitting.     

Exercise effects on withdrawal and mood among women attempting smoking cessation.

This study investigated both acute and longer term ("chronic") effects of vigorous exercise training on affect, nicotine withdrawal, and cigarette craving among women enrolled in a smoking cessation research study. All subjects participated in a 12-week cognitive behavioral smoking cessation program and were randomly assigned to attend three sessions per week of either a vigorous exercise program or contact control. Measures of positive and negative affect, cigarette craving, and nicotine withdrawal were administered immediately before, and again immediately after the final exercise or contact session each week of the program. Study I enrolled 24 women who had been assigned to the exercise condition. Significant reductions in negative affect, nicotine withdrawal and cigarette craving were observed following exercise most weeks of the program. No significant changes in positive affect were observed. In Study II this protocol was repeated among 62 women (44 exercise, 18 contact control) in two consecutive cohorts of the larger study. Significant reduction were observed in negative affect, nicotine withdrawal and cigarette craving during most weeks of the program among exercise subjects but not contact condition subjects. No chronic (baseline to posttreatment) changes in positive or negative affect, cigarette craving or withdrawal symptoms were observed in either study. Vigorous exercise appears to produce acute improvements in withdrawal symptoms, cigarette craving, and negative affect among sedentary women attempting to quit smoking.     

Cigarette reduction: an intervention for adolescent smokers

This observational study examined whether adolescents who were not interested in quitting could reduce cigarette smoking and if cigarette reduction led to a corresponding and significant reduction in biomarkers of exposure. The study design was a randomized, open-label trial of nicotine patch and nicotine gum with an added placebo control. Participants (n=103) attended 4 treatment visits over 4 weeks and follow-up visits at 3- and 6-months. Participants were told to reduce their smoking by 25% of baseline smoking during the 1st week and by 50% of baseline smoking during the subsequent 3 weeks. Of consented participants, 91.3% (n=94/103) completed the study until the end-of-treatment, 85.1% (n=80/94) completed the 3-month follow-up visit and 71.3% (n=67/94) completed the 6-month follow-up visit. Participants had a very high prevalence of co-morbidity. With regard to the percentage of participants who achieved a 50% reduction of baseline smoking, there were no significant differences among treatment groups (p=.89). At the end-of-treatment, 49.4% of participants (n=41) had reduced smoking by at least 50%. Additionally, there was no significant group, visit or interaction effect of a biomarker measure for carcinogen exposure (p>.05). The results suggest that reduction may be a potential aid to engage adolescents who are unable or unwilling to quit, but should not be an end goal. The effect of treatment methods on outcome measures did not differ significantly.     

Randomized controlled study on the effectiveness of community pharmacists' advice for smoking cessation by Nicorette--evaluation at three months after initiation

We conducted a randomized, controlled study to evaluate whether pharmacists' advice on smoking cessation would result in a higher smoking cessation rate using Nicorette (nicotine gum preparation). Fourteen pharmacies in Tokyo, Kanagawa, and Nagano participated. Smokers who visited pharmacies to buy Nicorette from March 1, 2002, through August 31, 2002, were recruited and randomly assigned to two groups. For the intervention group (A), pharmacists provided both regular instructions on Nicorette use and smoking cessation advice at the first sale and then gave follow-up advice just before starting a cessation and 1, 3, and 8 weeks and 3 months thereafter. For the control group (B), pharmacists provided regular instructions alone. The primary outcome measure was the self-reported smoking cessation rate and the secondary outcome measure was the relationship between the smoker's egogram and effectiveness of intervention. Twenty-eight smokers were enrolled and randomized into group A (n=11) or group B (n=17). The absolute abstinence rate in groups A and B at 3 months was 45.5% and 31.2%, respectively. The odds ratio was 1.83, which was not statistically significant. There was no difference in egogram score between absolute abstinence subjects and nonabstinence subjects in group A. The egogram scores in Adapted Child of absolute abstinence subjects in group B were significantly higher than in nonabstinence subjects. In conclusion, instructions and advice given by pharmacists may improve the smoking cessation rate in smokers receiving nicotine replacement therapy.     

Neuropsychological Measurement of Drug Effects: Polydrug Research

Abstract

This study examined the impact of treatment intensity on cocaine use. Seventy-seven cocaine-using methadone patients were enrolled in a six-month, structured, manual-driven, cognitive behavioral treatment program. Sessions consisted of five individual and/or group sessions per week. At intake subjects showed extensive polydrug abuse, psychiatric comorbidity, criminal histories, and HIV risk behaviors. Treatment intensity was measured by dividing number of sessions attended into quartiles. Paired comparisons, within treatment quartiles, were made between subjects' intake and six-month self-reports of cocaine use. Subjects in quartiles two through four showed significant reductions in frequency of cocaine use at follow-up, with subjects who received the most treatment showing the greatest reductions in cocaine use. Bivariate and multivariate analyses showed that treatment sessions attended remained a strong predictor of reduction in cocaine use at follow-up, even after controlling for drug use at intake and background variables. The results indicate that there is a substantial treatment dose-response relationship.     

A marijuana smoking cessation clinical trial utilizing THC-free marijuana, aversion therapy, and self-management counseling

Twenty-two volunteer adult chronic marijuana smokers participated in a smoking cessation clinical trial. The mean age of the 16 male and 6 female subjects was 29.8 years. The mean number of years of marijuana smoking was 13.7. The mean number of daily marijuana cigarettes smoked was 3.4. The clinical trial consisted of five consecutive days of 50 minute aversion therapy sessions (faradic, rapid smoking, and quick puffing) utilizing THC-free marijuana. Three weekly 60 minute group cohort sessions in self-management counseling followed. The treatment period spanned four weeks. Pretreatment and posttreatment (one month interval) the Shipley Institute of Living Scale was administered to measure changes in both cognitive functioning and organic brain dysfunction. All 22 subjects achieved abstinence (by self-report) by the end of the five days of aversion therapy; 19 of 21 subjects (90.5%) reported abstinence at the conclusion of the clinical trial, following the group sessions. At six months post treatment follow-up 15 of the 20 subjects (75.0%) reported abstinence; at 12 month posttreatment follow-up 16 of the 19 subjects (84.2%) achieved abstinence. The mean number of daily marijuana cigarettes smoked by the subjects decreased from a baseline pretreatment level of 3.40 to 0 at the conclusion of aversion therapy, .07 at the conclusion of the clinical trial, .26 at six month posttreatment follow-up and .23 at the 12 month posttreatment follow-up. The mean scores on the Shipley Institute of Living Scale, were: IQ 106 and CQ 92 at pretreatment; IQ 112 and CQ 104 at posttreatment. The difference in these means was significant for both intelligence and conceptual quotient. The investigators conclude that the treatment procedure offers promise as a marijuana smoking cessation treatment program.     

Ecological relevance of memory tests and the prediction of relapse in alcoholics

In an inpatient alcoholism rehabilitation program, 56 men were administered two 10-min memory tests: the Product Recall Test (PRT), designed to assess memory for familiar stimuli (assumed to be relatively high in ecological relevance), and the Memory-for-Designs Test (MFD), a test of memory for novel patterns of stimuli (assumed to be relatively low in ecological relevance). Approximately 74% of subjects who recalled less than or equal to half the items of the PRT relapsed at 3 months compared to only 33% of the subjects who recalled more than half the items. Performance on the MFD was not related to relapse rate. PRT performance was almost as predictive of relapse at 3 months as aftercare attendance, and combining both of these variables further improved predictability. The results suggest that the familiarity of the stimuli employed in memory tests may be important in tapping cognitive deficits of alcoholics that place these subjects at increased risk for relapse. The implication of these findings for the time-effective identification of early relapsers from alcoholism treatment programs are discussed.     

Joiners and non-joiners in smoking treatment: A comparison of psychosocial variables

Treatment joiners were differentiated from non-joiners in a smoking cessation clinic. Subjects were 108 smokers who attended an orientation session for a smoking cessation program. The primary variable of interest was perceived self-efficacy. Other variables studied were demographic characteristics, tobacco and drug use, anxiety, and health locus of control. Non-joiners were found to be more anxious, less educated, and had a lower self-efficacy expectation than treatment joiners.