The addition of social support to a community-based large-group behavioral smoking cessation intervention: improved cessation rates and gender differences

OBJECTIVE: To determine the effects on cessation rates of adding a partner support group component to a large-group community-based behavioral smoking cessation program. METHODS: During the past eight smoking cessation programs at the Tom Baker Cancer Centre in Calgary, Alberta, Canada, separate support group sessions were offered for support persons of prospective quitters. Six hundred smokers brought 156 support people with them to the groups. Cessation rates were calculated at 3, 6, and 12 months postquit. RESULTS: Those smokers who had support people attending at least one of the support group sessions had higher cessation rates at 3, 6, and 12 months (56%, 46%, and 43%) compared to those without a support person in attendance (36%, 35%, 32%). This effect was especially strong for men, with 3-, 6-, and 12-month cessation rates for those with support of 58%, 54%, and 56%, compared to 52%, 41%, and 36% in the women with support. For men without a support person, the rates were 34%, 35%, and 33%, compared to 38%, 35%, and 31% in women without support. This indicates that although support was initially effective for women, it had no effect on sustained abstinence. CONCLUSIONS: The addition of a support person group to a large-group behavioral smoking cessation program was effective in improving 3-month cessation rates in both men and women, but over 1-year of follow-up support was only associated with greater sustained abstinence in men.     

Social support and the transtheoretical model: Relationship of social support to smoking cessation stage, decisional balance, process use, and temptation

This study investigated the relationship between social support and the transtheoretical model (TTM) constructs for smoking cessation. A sample of 190 adult smokers in a Veteran's Administration smoking cessation clinic completed measures of demographics, social support, smoking cessation stage of change, decisional balance, process use, and self-efficacy. Regression analyses revealed that social support was positively associated with both experiential and behavioral processes of change. A trend for higher social support with advancing stage was also detected. Social support was not related to temptation or decisional balance. When looking at specific sources of social support, family and peer support emerged as significant predictors, while significant-other support did not.     

Current issues in behavioral and pharmacological approaches to smoking cessation

Over the last 15 years or so, innovative research in behavioral treatments (BT) has given way to research in nicotine replacement treatments (NRT), and there is a growing gap in scientific status between the two. There is little evidence that one BT is more effective than any other, while there is little doubt about the specific efficacy of NRT. Adding NRT to BT leads to large increases in efficacy, while adding BT to NRT is of uncertain value. In the clinical context, new BT ideas seem to have dried up, while vigorous research in NRT and other pharmacological treatments is currently underway. It is proposed that most BT have not been adequately examined and developed, and this and other reasons for their apparently poor record are explored. Some possible ways forward are discussed.     

Current approaches to the management of smoking cessation

Smoking remains a widespread intractable behaviour and is a significant cause of morbidity and mortality worldwide. Effective approaches to smoking cessation include behavioural intervention and pharmacotherapy, in particular nicotine replacement therapy (NRT) and sustained-release bupropion (bupropion SR). Pharmacotherapy remains a popular choice of smoking cessation intervention for many smokers, and both NRT and bupropion SR, combined with behavioural interventions, achieve 1.5- to >2-fold increases in smoking cessation rates. Various national and international smoking cessation guidelines have been published recommending effective implementation of smoking cessation strategies. Recommendations include the systematic identification of smokers, assessment of their willingness to quit smoking, provision of advice promoting a cessation attempt, and administration of approved first-line therapies.     

Adolescent smoking: epidemiology and approaches for achieving cessation

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

Religiosity, social support, and smoking cessation among urban African American smokers

This study examined the relationship between religiosity, social support, and gender on smoking cessation among a sample of 498 urban African American smokers using the nicotine patch. Smoking status and social support were assessed at baseline, week 4, and month 6, while religiosity was assessed only at baseline. Logistic regression analyses indicated that neither baseline religiosity, social support, nor the interaction between baseline social support and gender predicted quitting at month 6. However, a significant positive association was found between females' social support at week 4 and their week 4 (OR=1.41, CI=1.11-1.78) quitting. Additionally, a significant positive association was found between males' social support at month 6 and their month 6 quitting (OR=1.50, CI=1.05-2.15). Our findings highlight the importance of social support during an active quit attempt for African American males and females and have implications for public health and medical interventions for African American smokers.     

A comparison of self-help approaches to smoking cessation.

The current study evaluated the effectiveness of widely used self-help materials for quitting smoking. Five hundred and seventy smokers volunteered during a baseline survey to participate in the evaluation. After random assignment, 200 were mailed National Cancer Institute (NCI) "Quit for Good" materials, 200 the Minnesota "Quit and Win" program, and the remaining 170 were assigned to a nonintervention control condition. Results at 7-month follow-up failed to indicate treatment effects either for abstinence or for reported quit attempts. A number of smokers quit prior to the mailing of self-help materials, suggesting that a telephone prompt in itself may have been an important stimulus to cessation. Overall abstinence at follow-up was 10%. Contrary to expectation, successful participants were less likely to use a number of specific preparation strategies for quitting. The results are instructive in providing a large-scale assessment of self-help materials in a population of smokers that was not specifically seeking treatment.     

Self-help approaches to smoking cessation: a report from the normative aging study

Self-quitters make up by far the largest proportion of ex-cigarette smokers, yet this population has not been extensively characterized to date. We compared male self-quitters (N = 191) and age-matched recidivists (N = 110) on smoking histories, psychosocial attributes and quitting methods. A number of significant relationships were found, some of which may have clinical implications. those who substituted cigars or pipes for cigarettes were nearly four times more likely to be successful, and those who reported consuming more food/snacks after quitting were 80% more likely to be successful quitters. Subjects who reported using no coping strategies in former smoking settings after cessation because they had no urges to smoke in these settings were also much more likely to be successful quitters. Recidivists were more likely to report using physical activity as a means of coping with temptations to smoke, and were somewhat older at the time of the quit attempt. Withdrawal symptoms and psychosocial stress were reported as reasons for relapse by early relapsers, while late relapsers reported being around other smokers on social occasions, and psychosocial stress.     

Cognitive and social influence factors in adolescent smoking cessation

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

Response to social stress, urge to smoke, and smoking cessation

Motivational theories of drug use have assigned negative affect a central role in determining drug urges and drug relapse. The purpose of this study was to examine the effects of social stress on smoking urges in a controlled laboratory setting, and the relation of these responses to short-term (3-month) smoking cessation outcomes. Prior to a clinic-based smoking cessation program, 76 (64% female) smokers were assessed for their affective, cognitive, and physiological responses during the Borkovec social anxiety induction procedure. These responses were used to predict smoking urges immediately after the procedure and to predict abstinence at 3-month follow-up posttreatment. As expected, during the induction, urge to smoke was positively associated with anxiety ratings and negatively associated with self-efficacy to resist smoking. However, only heart rate increase and behavioral social skill (observed by independent judges) predicted smoking abstinence at 3 months. These results suggest that subjective affective and efficacy responses during a stressful social encounter are associated with smoking urges; however, urges and these responses may be related in different ways to the probability of smoking cessation.     

The commitment to quitting smoking scale: initial validation in a smoking cessation trial for heavy social drinkers

We tested the psychometric properties and predictive validity of a newly developed 8-item measure of commitment to quitting smoking, conceptualized as the state of being personally bound or obligated to persist in quitting smoking despite potential difficulties, craving and discomfort. Participants were 157 heavy drinking smokers enrolled in a clinical trial of smoking cessation treatments. The measure showed strong unidimensionality, good internal consistency, and moderate stability from baseline to quit date. Commitment significantly increased from baseline to quit date. Higher commitment to quitting at baseline predicted greater odds of abstinence at post-treatment and 16 and 26 weeks after quit date. Commitment predicted smoking outcome over and above level of tobacco dependence, self-reported importance of quitting smoking, and self-efficacy for remaining abstinent. Results suggest that commitment is a highly relevant construct for smoking cessation, which can be reliably assessed with the Commitment to Quitting Smoking Scale and which may be an excellent target for smoking cessation treatments.     

A stage paradigm for integrating clinical and public health approaches to smoking cessation

Clinical interventions for the addictions typically generate the highest abstinence rates but the lowest participation rates. Public health interventions reach the largest percentage of populations but have the lowest efficacy. Applying a stage paradigm to smoking cessation can integrate the clinical and public health approach and generate unprecedented impacts. Theoretical, empirical, and practical examples are provided for enhancing five issues in intervention: recruitment, retention, progress, process and outcomes.     

Adding addiction to the transtheoretical model for smoking cessation

Addiction is important to account for when designing smoking cessation interventions as withdrawal symptoms impede quitting. Ameliorating symptoms may increase those successfully quitting. A two-group, two-time, five-week, multi-site experimental design using the Transtheoretical Model examined whether addiction predicted post-intervention smoking behavior (point prevalence and stage of change), controlling for NRT (nicotine replacement therapy use) in adult FreshStart participants (N=109). The intervention group self-designated an Indigenous Helper (IH) Inde from their social network; the control group did not. The Fagerstrom Test for Nicotine Dependence (FTND) and the Stage of Change questionnaire were completed at baseline and 4 weeks. NRT use, but not the FTND, predicted smoking behavior. There is a need for an accurate nicotine addiction measure. Future smoking cessation studies should include NRT as a covariate.     

Using the text-messaging program SmokefreeTXT to support smoking cessation for nondaily smokers

Introduction: Smoking cessation interventions for nondaily smokers are needed. The current study explores the fit of the text-messaging intervention SmokefreeTXT for nondaily smokers. Methods: Adult nondaily smokers (N?=?32; mean age?=?35?±?12, 64% female, 53% non-Hispanic White) were enrolled in SmokefreeTXT. SmokefreeTXT usage data were recorded passively, theorized mechanisms of change were assessed at baseline and 2, 6, and 12?weeks after the chosen quit day, and EMA protocols captured real-time cigarette reports at baseline, and during the first two weeks after the quit day. Results: Most participants completed the SmokefreeTXT program and responded to system-initiated inquiries, but just-in-time interaction with the program was limited. In retrospective recall at treatment end, content of the text-messages was rated as “neutral” to “helpful.” Within-person change was observed in theorized mechanisms, with less craving (p?<?0.01), increased abstinence self-efficacy (external: p?<?0.01; internal: p?<?0.01), and poorer perceptions of pros of smoking (psychoactive benefits: p?<?0.01, pleasure p?<?0.01; and pros: p?<?0.01) reported after SmokefreeTXT initiation compared to baseline. Exploratory analyses of real-time reports of smoking (225 cigarette reports in N?=?17 who relapsed) indicated that cigarettes smoked in the first two weeks after quitting were more likely to occur to reduce craving (OR?=?2.21[1.21–3.72]), and less likely to occur to socialize (OR?=?0.06[0.01–0.24]), between 19:00 and 23:00 (OR?=?0.34[0.17–0.66]), and on Saturdays (OR?=?0.59[0.35–0.99]) than prior to quitting. Conclusions: While well accepted by nondaily smokers, SmokefreeTXT could potentially be improved by targeting cons of smoking, enhancing engagement with the just-in-time component of SmokefreeTXT, and tweaking the timing of text-messages.     

Systematic review of social media interventions for smoking cessation

BackgroundPopular social media could extend the reach of smoking cessation efforts. In this systematic review, our objectives were: 1) to determine whether social media interventions for smoking cessation are feasible, acceptable, and potentially effective; 2) to identify approaches for recruiting subjects; and 3) to examine the specific intervention design components and strategies employed to promote user engagement and retention.MethodsWe searched Scopus, Medline, EMBASE, Cochrane Central, PsychINFO, CINAHL, and Web of Science through July 2016 and reference lists of relevant articles. Included studies described social media interventions for smoking cessation and must have reported outcomes related to feasibility, acceptability, usability, or smoking-related outcomes.ResultsWe identified 7 studies (all were published since 2014) that enrolled 9755 participants (median = 136 [range 40 to 9042]). Studies mainly used Facebook (n = 4) or Twitter (n = 2), and emerged as feasible and acceptable. Five studies reported smoking-related outcomes such as greater abstinence, reduction in relapse, and an increase in quit attempts. Most studies (n = 6) recruited participants using online or Facebook advertisements. Tailored content, targeted reminders, and moderated discussions were used to promote participant engagement. Three studies found that active participation through posting comments or liking content may be associated with improved outcomes. Retention ranged from 35% to 84% (median = 70%) across the included studies.ConclusionsOur review highlights the feasibility, acceptability and preliminary effectiveness of social media interventions for smoking cessation. Future research should continue to explore approaches for promoting user engagement and retention, and whether sustained engagement translates to clinically meaningful smoking cessation outcomes.