Effects of partner smoking status and gender on long term abstinence rates of patients receiving smoking cessation treatment

AIMS: To assess the effect of partner smoking status on the success of a cessation program. DESIGN: Prospective cohort. SETTING: Smoking Cessation Unit in Hospital of Bellvitge (Hospitalet de Llobregat, Barcelona). PARTICIPANTS: A total of 1516 smokers of 10 or more cigarettes who started a smoking cessation program between January 1995 and December 2001 were included. MEASUREMENTS: All patients gave information about smoking history and smoking partner status. Abstinence was determined by carbon monoxide exhaled. FINDINGS: Significant differences were found in the abstinence rates at 12 months by smoking partner status: abstinence was achieved by 28.3% of patients with smoking partner, and by 46.5% of patients without smoking partner (p<0.001). Subjects whose partner was smoking at the beginning of the program appear to be more likely to relapse than subjects without smoking partners (p<0.001) and this is more pronounced in women than in men. However no significant gender differences were found in any group of smoking partner status. CONCLUSIONS: Having a smoking partner is a determinant of relapse 1 year after the beginning of the cessation program. Interacting not just with the smoker, but also with his or her partner, could neutralize interpersonal influences making smokers more accessible to behavioural and pharmacological techniques.     

Clinical phenotypes related to smoking cessation

Introduction

The aim of the current study is the identification of clinical phenotypes of patients visiting a specialized smoking cessation center and the determination of smoking cessation rate for each phenotype, 1 year after the initial evaluation.

Methods

Seven hundred eighty-three smokers who visited the outpatient clinic were included in the study. Demographic data, smoking habits, tobacco dependence and comorbidities were recorded. Smoking cessation rates and carbon monoxide levels were determined 1 year after the initial evaluation.

Results

Τhe overall smoking cessation rate 1 year after the initial evaluation was 32.3%. Four distinct phenotypes were identified. The first one included mainly young women with low tobacco dependence and allergic profile. The second and the third ones included mainly men with high tobacco dependence, without comorbidities, treated with varenicline and bupropione SR, respectively. The fourth one included mainly older men with high tobacco dependence and smoking related comorbidities. Smoking cessation rates for each phenotype were 33.8, 39.4, 23.3, and 24.6%, respectively.

Conclusion

Patients visiting a specialized smoking cessation center can be categorized in different phenotypes. Phenotyping may lead to a more personalized approach concerning smoking cessation.     

戒烟行动期患者抑郁状况及其影响因素分析

目的：调查戒烟行动期患者的抑郁状况及其影响因素,分析抑郁与社会支持的关联性。方法采用抑郁自评量表和社会支持评定量表对123例戒烟行动期患者进行问卷调查。结果戒烟行动期患者抑郁发生率为33.33%,抑郁标准分为48.12±9.27,分析发现不同婚姻状况、不同职业、不同烟草依赖程度的患者抑郁得分存在差异;此外患者抑郁标准分与社会支持总分呈负相关关系（r=-0.19,P<0.05)。结论戒烟行动期患者抑郁状况与社会支持之间存在显著相关,加强主观支持及对支持的利用度有助于降低抑郁的发生率。     

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.     

Correlates of expected positive and negative support for smoking cessation among a sample of chronically ill veterans

Objective

To examine demographic, relationship, and smoking history factors related to expected positive and negative support for quitting smoking among chronically ill veterans.

Methods

Data for this report comes from baseline data from a randomized controlled trial of a support-based smoking cessation intervention for veterans with chronic diseases (cancer, cardiovascular disease, hypertension, diabetes, and chronic obstructive pulmonary disease). We used separate multiple linear regression models to analyze relationships between positive and negative support and variables selected for model entry.

Results

Veterans in our sample expected high positive and negative support for quitting. Veterans who were married/living as married, had some college education, were female, or named a female support person expected higher levels of positive support. Veterans who named a female or a nonsmoker as a support person expected higher levels of negative support. Males and non-Caucasians also reported higher levels of expected negative support.

Conclusions

Individual differences that influence perceptions of expected support are likely to influence intervention participation and engagement. Thus, understanding factors associated with expected positive and negative support is necessary to optimize future implementation of support-based cessation interventions through better treatment matching.     

慢性心衰患者吸烟及戒烟依从性影响因素的临床研究

目的临床研究慢性心衰患者吸烟及戒烟依从性的影响因素。方法选取我院有吸烟史的慢性心衰患者200例,本研究采用问卷方式进行调查,研究所用量表综合了Fager-strom尼古丁依赖性评分表及2006年中国国际戒烟竞赛随访调查表的内容,并结合慢性心衰患者情况进行调整。结果对慢性心衰患者吸烟及戒烟依从性影响因素进行分析研究,可明显提高戒烟率,文化程度高,依从性相对较好,已戒烟者占80％;文化程度低,依从性相对较差,戒烟者只有20％,家庭成员支持戒烟的比例,戒烟者为85％,高于家庭成员不支持戒烟的比例55％。讨论戒烟是慢性心衰患者最有力的干预方法之一,帮助患者戒烟成为慢性心衰诊治工作不可缺少的部分。烟草依赖是一种慢性成瘾性疾病,具有高复发的特点,自行戒烟率低,必须将烟草依赖作为一种慢性病对待,予以评估并反复干预。     

Race differences in factors relating to smoking initiation

To investigate race differences in retrospectively-reported early smoking experiences, we studied African-American (n = 48) and Caucasian (n = 155) current smokers who participated in a study designed to identify phenotypic and genotypic factors associated with smoking. Compared with Caucasian smokers, African-American smokers were less educated (mean ± s.e.m.: 13.3 ± 0.25 vs. 14.3 ± 0.16; p < .01), had higher BMI (28.9 ± 1.06 vs. 26.7 ± 0.52; p < .05), and smoked significantly fewer cigarettes/day (14.1 ± 1.00 vs. 18.4 ± 0.74; p < .01). Ninety percent of African-American smokers consumed menthol cigarettes, as opposed to 25% of Caucasian smokers. African-American smokers were significantly older than Caucasian smokers upon initial smoking experimentation (17.4 ± 1.1 vs. 14.7 ± 0.3; p < .05) and onset of regular smoking (19.7 ± 0.9 vs. 17.4 ± 0.4; p < .05). African-American smokers were significantly more likely than Caucasian smokers to endorse global pleasurable sensations (48% vs. 30%; p < .05), “pleasurable rush or buzz” (62% vs. 43%; p < .05), and “relaxing” (45% vs. 27%; p < .05) as early experiences with smoking, whereas Caucasian smokers were marginally more likely to report dizziness and difficulty inhaling (61% vs. 45%; p < .10 and 48% vs. 31%; p < .10, respectively). Caucasian smokers were significantly more likely to endorse friends (6.9 ± 0.2 vs. 4.8 ± 0.4; p < .0001) and “perk me up” (4.2 ± 0.3 vs. 3.1 ± 0.4; p < .05) and marginally more likely to endorse buzz (4.2 ± 0.2 vs. 3.4 ± 0.5; p < .10) as reasons for starting to smoke. Further research is needed to determine the relative contributions of genetic, developmental, and socio-cultural factors to these findings.     

Acute exercise effects on smoking withdrawal symptoms and desire to smoke are not related to expectation

Rationale Recent research has shown that 10 min of moderate intensity exercise reduce smoking withdrawal symptoms and desire to smoke in acutely abstinent smokers. The aim of the current study was to determine whether the reductions are related to participant expectation of these effects. Materials and methods Forty-five sedentary participants who had smoked ten or more cigarettes per day for at least 3 years reported their expectation of the effects of exercise on smoking withdrawal symptoms. Approximately 1 month later, participants were randomly assigned to one of three groups after 11–15 h of overnight smoking abstinence. Each group read either a positive, negative or neutral statement concerning exercise effects on smoking withdrawal symptoms. They rated their expectation again and then completed 10 min of moderate intensity exercise on a stationary bicycle ergometer. Using standardised scales, participants rated smoking withdrawal symptoms and desire to smoke at 10, 5 and 0 min before exercise, then at 5 and 10 min during exercise and 15 and 20 min post-exercise. Results Expectation of exercise effects on withdrawal were manipulated in the predicted directions. No significant group main effects were found for any symptom. Significant reductions in symptoms and desire to smoke occurred during and after exercise regardless of participant expectation. Conclusions Ten minutes of moderate intensity exercise can lead to reductions in desire to smoke and smoking withdrawal symptoms, which are not due to the participant’s expectation of exercise effects. These findings support the use of short periods of exercise as an aid to smoking cessation.     

General and smoking cessation related weight concerns in veterans

This study sought to assess general and cessation related weight concerns in Veterans presenting for QuitSmart, a tobacco cessation program used extensively in the Veteran Affairs system. Assessed were prevalence rates of cessation related weight concerns, the weight at which concerned Veterans would relapse to smoking, characteristics of weight concerned Veterans, and the impact of weight concerns on cessation at the program's end and at the 1-month follow-up. Sixty-seven Veterans participated. Of those, 63 were eligible for cessation analyses. Results suggested that 26.9% were concerned about post-cessation weight gain, the mean and median weights tolerated before relapse were in the 10-12 lb range, and weight concerned Veterans were more likely younger with more general weight concerns. At both time points, Veterans with general weight concerns were much more likely to quit smoking than those without such concerns. At neither time point, were post-cessation weight concerns significantly associated with quit status, though specific concerns remained in predictive models and trends suggested those with cessation related weight concerns were less likely to quit smoking than those without such concerns. Results suggest a significant prevalence rate of general and cessation related weight concerns in Veterans attempting to quit smoking, greater success in doing so if weight concerns are general in nature, and the need to continue to assess these relationships and develop effective cessation treatments for this population.     

戒烟和吸烟对门诊初治培阳肺结核患者的影响

目的：探讨吸烟和戒烟对门诊初治培阳肺结核患者治疗结果的影响。方法102例门诊吸烟初治培阳肺结核患者分为吸烟组和戒烟组,吸烟组根据吸烟指数再分为两个亚组（第1组,200年支≤吸烟指数〈800年支,28例;第2组,吸烟指数≥800年支,26例）,对两组患者的2个月末痰菌培养的痰菌阴转率对比分析。结果吸烟组2个月末痰菌培养阴转率（87.0%）,明显低于戒烟组（95.8%）,两组相比差异具有统计学意义（P〈0.05）。吸烟指数≥800年支组痰培养阴转率（80.7%）明显低于吸烟指数200年支≤吸烟指数〈800年支组（92.8%）,两组相比差异具有统计学意义（P〈0.05）。结论吸烟是使门诊初治培阳肺结核患者2个月痰菌培阳性率增高的重要因素,并影响化疗效果。提倡戒烟是减少肺结核传染源、保护易感人群的简单而有效的方法。     

Effects of exercise on craving and cigarette smoking in the human laboratory

Exercise is increasingly being pursued as a treatment to reduce cigarette smoking. The efficacy of clinical, exercise-based cessation interventions may be enhanced by conducting laboratory studies to determine maximally effective conditions for reducing smoking, and the mechanisms through which the effects on smoking are achieved. The main purpose of this study was to assess whether the effects of exercise on two components of craving (anticipated reward from smoking, anticipated relief from withdrawal) mediated the relationship between exercise and delay (in min) to ad libitum smoking. Experiment 1 (N = 21) assessed the effects of exercise intensity (inactivity, low, moderate) on craving components up to 60 min post-exercise. Because moderate-intensity exercise most effectively reduced craving on the reward component, all participants exercised at a moderate intensity in Experiment 2. Using an ABAB within-subjects design, Experiment 2 (N = 20) evaluated whether the effects of moderate-intensity exercise on reward and relief components of craving mediated the relationship between exercise and participants' delays (in min) to ad libitum smoking. Delays were significantly longer after exercise (M = 21 min) versus inactivity (M = 4 min), and the effects of exercise on delay were mediated through the reward component of craving. Future research should continue to explore the mechanisms through which exercise influences behavioral indices of smoking in the human laboratory. Additionally, given the benefits uniquely afforded by exercise-based cessation interventions (e.g., improving mood and other health outcomes), implementing these interventions in clinical settings may contribute substantially to improving public health.     

Better Late Than Never: The Perceived Benefits of Smoking Cessation Among Women in Late Midlife

The current study examined the association of smoking cessation (≥1 year without relapse) and self-reported psychosocial and physical outcomes among a community sample of women (N = 195; mean age = 63.7 years, SD = 5.7 years). Data were collected in 1985–1986 and 2009. Successful smoking cessation for ≥1 year was significantly associated with each of the outcome measures (e.g., less financial stress [adjusted odds ratio (AOR) = 0.50; 95% confidence interval (CI) = 0.25–1.00, P< 0.05), less life dissatisfaction (AOR = 0.51, 95% CI = 0.24–1.09, P< 0.05). Findings suggest that older women should be included in smoking cessation programs, and the important benefits of quitting should be used to encourage cessation.     

Cigarette smoking and interest in quitting in methadone maintenance patients

OBJECTIVES: To examine tobacco use, readiness to quit, and interest in smoking cessation interventions among methadone maintenance patients. METHODS: Cross-sectional survey of outpatients enrolled in four urban methadone maintenance clinics. Stage of readiness to quit was determined for all smokers, and factors associated with both readiness to quit and interest in attending an on-site smoking cessation program were determined. RESULTS: Among 389 patients, 83% were current smokers. Nearly half (48%) of smokers were contemplating quitting, and an additional 22% were in the preparation stage of readiness to quit. In multivariate analyses, lower nicotine dependence, prior use of smoking cessation pharmacotherapy, and lower methadone dose were associated with being in the preparation stage. Patients with more education, Hispanics/Latinos, and patients who had used smoking cessation pharmacotherapy or were in the preparation or contemplation stages of behavior change were more interested in attending an on-site smoking cessation program. CONCLUSIONS: Tobacco use is highly prevalent among methadone maintenance patients, but we also observed a high level of readiness to quit and interest in smoking cessation. Targeted smoking cessation interventions, including on-site programs, should be developed for methadone maintenance patients.     

Diurnal variations in first lapses to smoking for nicotine patch users

Amongst those not using nicotine replacement therapy (NRT), first lapses to smoking have been shown to be more common in the afternoons and evenings than the mornings. The present study investigated whether first lapses amongst those using 16 h nicotine patches follow a similar pattern. This is of interest because 16 h patches may not provide sufficient nicotine early in the morning to meet the needs of smokers. 200 male and female smokers attended a cessation programme combining behavioural support and 16 h nicotine patches. During the first 2 weeks of smoking abstinence 70 smokers reported first lapses. The frequency of first lapses was significantly higher in the afternoons (12.00-18.00 h, 30 lapses) and evenings (18.00-24.00, 35 lapses) than in the mornings (24.00-12.00, five lapses, p < 0.001 for both comparisons). There was no detectable difference between the rates of first lapse in the afternoon and evening. In conclusion, abstaining smokers using 16 h nicotine patches are more likely to experience their first lapse in the afternoon or evening rather than in the morning. Despite nicotine patches providing limited nicotine replacement for the first few hours after waking, there is no evidence that this undermines quit attempts by failing to prevent lapses during that time.     

Interest in treatments to stop smoking

We surveyed 884 Vermont (VT) tobacco smokers by random digit dialing to determine past and future use of treatment. Among those who had recently attempted to quit, 61% had ever used a treatment, 21% had ever used a psychosocial treatment, and 57% had used a medication. Among those who planned to quit in the next month, 68% stated they would use a treatment, 35% would use a psychosocial treatment, and 62% would use a medication. The major predictors of past or future use of treatment were greater cigarettes per day, older age, being a woman, and seeing a health professional. Although this survey suggests many smokers have used or plan to use a smoking cessation treatment, program data indicate less than 10% of VT smokers who try to quit use the state quitline, counseling, or free medication provision. Why smokers do not use these treatments needs to be determined.     

History of smoking and postcessation weight gain among weight loss surgery candidates

Smoking cessation often results in weight gain. Although smoking cessation frequently is recommended to patients presenting for weight loss surgery (WLS), the relationship between smoking cessation and weight gain among WLS candidates is poorly understood. Thus, we sought to document the history and prevalence of smoking and smoking-related weight gain among WLS candidates. Subjects (N=67) presenting for bariatric surgery provided demographic information, were interviewed about smoking, and were weighed and measured prior to operation. Sixty-seven percent of patients reported a lifetime history of smoking, and 26.9% were current smokers. Among lifetime smokers who had attempted to quit, the average maximum amount of weight gained following smoking cessation was 28.1 lb, but there was wide variability in postcessation weight gain. These data suggest that smoking among candidates for bariatric surgery is prevalent and that previous cessation attempts were associated with considerable weight gain. Because patients often receive recommendations to quit smoking and lose weight prior to surgery, additional information on the impact of presurgical smoking cessation on long-tem weight control in this population is needed.     

A meta-analysis provides evidence that prenatal smoking exposure decreases age at menarche

Since studies of association between prenatal tobacco exposure and age at menarche have reported inconsistent results so far, we conducted a meta-analysis to examine this association. In total 36 relevant articles (1995–2014) were identified, 17 of which satisfied the inclusion criteria and were used in the analysis. Nearly one month decrease (−0.092 [95% CI:−0.160, −0.024] year) in age at menarche was found in women who were exposed to tobacco in utero. The meta-regression analysis showed that average year of birth in the cohorts might significantly influence association between maternal smoking and daughter’s age at menarche. Based on results obtained from 5 studies where age at menarche was treated as a categorical variable, maternal smoking status during pregnancy increased a risk for daughters to have menarche earlier than at 11 years old by 15%.     

Transdermal nicotine in smoking cessation

Summary A systematic search of the literature was made to identify relevant reports of clinical trials of transdermal nicotine, followed by detailed statistical analysis of the results to calculate a pooled estimate of the rate of smoking cessation. Both a fixed effect and a random effects model were used to calculate pooled estimates.The pooled odds ratio (OR) for short-term smoking cessation in favour of the transdermal patches was OR=3.10. Using a random effects model, the risk difference (RD) in favour of the transdermal patches was RD=0.25. The corresponding values for long-term cessation were OR=2.26 and RD=0.11. Skin irritation was a common adverse effect with incidence rates ranging up to about 70%.Nicotine transdermal patches were effective in promoting smoking cessation both in the short-term, with assessments at 3 to 10 weeks, and in the long-term, with assessment at 24 to 52 weeks. Long-term abstinence rates in subjects treated with nicotine patches for a few weeks remained higher than in subjects treated with placebo patches. Adverse effects were usually minor and transient, although subjects with a sensitive skin may find the applications intolerable. Further studies are required to confirm the value of nicotine patches in promoting smoking cessation in the absence of professional medical support and in general medical practices in the community.     

Predictors of the participation of smoking parents in a proactive telephone-based smoking cessation program

OBJECTIVE: The objective of this study is to identify the predictors of participation by smoking parents in a proactive telephone-based smoking cessation program. METHODS: The smoking parents of young children from a birth cohort were interviewed and invited to take part in a telephone-based smoking cessation program. The characteristics of the parents and the predictors of participation were analyzed by chi-square test and by logistic regression. RESULTS: A total of 952 (82.9%) out of the 1149 smoking parents who were interviewed agreed to participate in the smoking cessation program. The analysis showed that the predictors of participation in a pro-active smoking cessation program are being from a middle-income household, being currently employed, having recently had a medical consultation or been hospitalized, being at the stage of contemplating a change in behavior, and perceiving the importance of quitting smoking. CONCLUSIONS: Recruitment approaches should be refined according to the identified factors to target those who might decline an invitation to participate in a smoking cessation program.     

Failure to report attempts to quit smoking

Introduction

Accurately assessing quit attempt history is important to develop population estimates of cessation and to increase our understanding of smoking trajectories. Thus, the current study investigated failure to report quit attempts as a function of length of quit attempt by time since quit attempt over the past year.

Methods

The present study used data from the Smoking Toolkit Study, a series of population-based surveys of smokers and recent ex-smokers in England aged 16 years and older. Among the 11,772 smokers identified at baseline (24.4% of the total sample), this study focused on the 4234 participants (36.0% of current smokers) who reported between one and three quit attempts in the past year.

Results

There was a strong trend for quit attempts that lasted for shorter periods of time to fail to be reported. After three months, 90.1% of those lasting less than one day, 63.7% of those lasting between a day a one week, and 38.9% of those lasting between one week and one month failed to be reported.

Conclusion

A large proportion of unsuccessful quit attempts fail to be reported, particularly if they only last a short time or occurred longer ago. Therefore, population estimates of quit attempts based on retrospective data may be considerable underestimates and estimates of the success of quit attempts may be overestimates. Future research is needed to establish whether there is differential reporting of quit attempts as a function of features of attempts such as use of cessation aids.