Goals indicate motivation to quit smoking

AIMS: To test if goals indicate motivation to quit smoking and predict which smokers will make a quit attempt. DESIGN: A 28-day natural history feasibility study of smoking cessation and reduction. SETTING: The study was conducted via telephone calls and mailings. PARTICIPANTS: A total of 186 cigarette smokers. MEASUREMENTS: At baseline participants reported one of the following goals for the next 30 days: to quit abruptly, quit gradually, reduce but not quit, or not change their smoking. They also reported motivation to quit smoking on an Intention to Quit Ladder. Throughout the study they reported their cigarette consumption via daily telephone messages. FINDINGS: Self-reported motivation to quit differed among goals (F = 286.6, df = 3, P < 0.01). Goals significantly predicted the likelihood of making a quit attempt in the 28 days of the study. In comparison to smokers with the goal of not changing, smokers with a goal of quitting abruptly were more likely to make a quit attempt [relative risk (RR) = 9.6, P < 0.01], as were those with a goal of quitting gradually (RR = 4.5, P = 0.01). Those with a goal of reducing only appeared to be more likely to make a quit attempt than those with a goal of not changing, but the difference was not statistically significant (RR = 3.1, P = 0.15). Smokers with a goal of quitting abruptly were more likely to make a quit attempt than those with a goal of quitting gradually (RR = 2.1, P < 0.05). CONCLUSIONS: Goals indicate not only preferred method of change but also motivation. Differences in gradual versus abrupt cessation outcomes may be due to motivational rather than methodological differences. Those who plan to quit gradually or reduce only may need additional motivational interventions.     

Very low rate and light smokers: smoking patterns and cessation-related behaviour in England, 2006-11

Aims There is a growing interest in very low rate [fewer than one cigarette per day (CPD)] and light (one to nine CPD) smokers and in some parts of the world their numbers appear to be increasing. This paper examined changes in prevalence over the past 5 years, cessation patterns, and smoking and demographic characteristics of very low rate, light and moderate‐to‐heavy (10+ CPD) smokers in England. Design Cross‐sectional and longitudinal data from aggregated monthly waves of a household survey: the Smoking Toolkit Study. Setting England. Participants A total of 23 245 smokers interviewed between November 2006 and May 2011 and 4147 who provided data at 6‐month follow‐up. Measurements We compared the demographic and smoking characteristics between the three groups of smokers at baseline, and the rate of attempts to quit, use of aids to cessation and success of quit attempts at follow‐up. Findings Very low rate smoking remained extremely rare (1.9% of smokers in 2006 to 2.8% in 2011), but light smoking became increasingly common (23.9–32.8%). Compared with moderate‐to‐heavy smokers, very low rate and light smokers were younger, more often female and from a higher socio‐economic background. They were more motivated to quit and enjoyed smoking less. During the 6‐month follow‐up period, light smokers, but not very low rate smokers, were more likely to attempt to quit than moderate‐to‐heavy smokers. When they tried to quit, very low rate and light smokers used aids to cessation less than moderate‐to‐heavy smokers but still used them to a substantial degree: 18%, 31% and 44% used over‐the‐counter nicotine replacement therapy in their most recent quit attempt for the three types of smoker, respectively. Even very low rate smokers had a substantial failure rate: 65% failed in their most recent quit attempt within 6 months. Conclusions Very low rate (fewer than one cigarette per day) and light (one to nine cigarettes per day) smokers in England are at least as motivated to quit as heavier smokers. Although they use cessation medication less than heavier smokers and are more likely to succeed, they still use such medication and fail in quit attempts to a substantial degree.     

A randomized controlled trial of a smoking reduction plus nicotine replacement therapy intervention for smokers not willing to quit smoking

Aims To examine the effectiveness of smoking reduction counselling plus free nicotine replacement therapy (NRT) for smokers not willing to quit. Design, setting and participants A total of 1154 Chinese adult smokers not willing to quit but who were interested in reducing smoking were allocated randomly to three arms. Intervention group A1 (n = 479) received face‐to‐face counselling on smoking reduction and adherence to NRT at baseline, 1 week and 4 weeks with 4 weeks of free NRT. Group A2 (n = 449) received the same intervention, but without the adherence intervention. Control group B (n = 226) received simple cessation advice at baseline. Measurements Self‐reported 7‐day point prevalence of tobacco abstinence and reduction of cigarette consumption (≥50%) at 6 months and continuous use of NRT for 4 weeks at 3 months. Findings Using intention‐to‐treat analysis, compared to control group B, the intervention groups (A1 + A2) had achieved higher 6‐month tobacco abstinence (17.0% versus 10.2%, P = 0.01) and reduction rates (50.9% versus 25.7%, P < 0.001). There was no significant difference in the 4‐week NRT adherence rate at 3 months, but group A1 achieved a higher abstinence rate than group A2 at 6 months (20.9% versus 12.9%; P = 0.001). Conclusions In smokers with no immediate plans to quit, smoking reduction programmes with behavioural support and nicotine replacement therapy are more effective than brief advice to quit. Current guidelines recommend advice to quit on medical grounds as the best clinical intervention in this group of smokers, but smoking reduction programmes offer an alternative and effective option.     

Use of nicotine replacement therapy for smoking reduction and during enforced temporary abstinence: a national survey of English smokers

Aims To assess the prevalence of nicotine replacement therapy (NRT) use for smoking reduction (SR) and temporary abstinence (TA), the association between the two and the strength of the association between NRT use for SR or TA and socio‐demographic characteristics, cigarette consumption and past quit attempts. Design Cross‐sectional monthly surveys. Setting England. Participants A total of 11 414 smokers. Measurements Participants were asked (i) whether they were reducing the amount they smoked: if so, whether they used NRT; and (ii) whether they used NRT for TA. Demographic characteristics, daily cigarette consumption and whether a quit attempt had been made in the past 12 months were also assessed. Findings Of the participants, 56% were attempting SR, 14% were using NRT for SR and 14% were using NRT for TA. Use of NRT for SR and TA were highly correlated. The nicotine patch was the most commonly used form of NRT. The use of NRT for SR, compared with unassisted SR, was more common among older smokers, while the use of NRT for TA was more common among women. Cigarette consumption was higher in those using NRT for SR than those attempting SR without NRT. The use of NRT for SR and TA was associated positively with past quit attempts. Conclusions Nicotine replacement therapy use for smoking reduction and temporary abstinence is common in England. The use of NRT for SR and TA does not appear to be associated with lower cigarette consumption relative to SR or TA without NRT, but is associated with a higher rate of past quit attempts.     

Smoking reduction promotes smoking cessation: results from a double blind, randomized, placebo-controlled trial of nicotine gum with 2-year follow-up

Aim To test the effect of nicotine gum and placebo in smokers not motivated or not able to quit smoking with regard to smoking reduction and smoking cessation. Design This randomized study evaluated nicotine gum versus placebo for up to 1 year in 411 healthy smokers highly motivated to reduce cigarette use. Smoking reduction was defined as self‐reported daily smoking less than 50% of baseline and any decrease (1 p.p.m. or more) in carbon monoxide. Setting Pulmonary department, Copenhagen, Denmark. Findings The overall success rate for sustained smoking reduction was significantly higher at all time‐points for active versus placebo gum (6.3% versus 0.5% after 24 months). Nicotine gum achieved significantly higher point prevalence cessation rates than placebo at 12 and 24 months [11.2% versus 3.9% (odds ratio = 3.1; 95% CI, 1.4–7.2 and 9.3% versus 3.4% (odds ratio = 2.9; 95% CI, 1.2–7.1), respectively]. There was a linear relationship between decrease in number of daily cigarettes and decrease in plasma cotinine, exhaled carbon monoxide and plasma thiocyanate, with significantly greater reduction in the nicotine gum group after 4 and 12 months (maximum treatment duration) but not after 24 months. The decrease in toxin intake was smaller than the decline in daily cigarette consumption, suggesting that compensatory smoking occurred. Conclusions Nicotine gum promoted cessation in this population of smokers unwilling to quit. Among reducers, the toxin intake correlated with reduced cigarette consumption although some compensatory smoking occurred.     

Role of snus (oral moist snuff ) in smoking cessation and smoking reduction in Sweden

Aims To assess to what extent snus has been used as an aid to stop smoking among Swedish smokers. Design A random telephone retrospective survey of Swedish smokers and ex‐smokers. Setting Survey conducted in November–December 2000. Participants A national sample of 1000 former and 985 current daily smokers aged 25–55 years. Measurements Smoking status, date and method of quitting by self‐report. Findings Thirty‐three per cent of former smokers and 27% of current smokers had ever used snus. The difference was larger among men (55% versus 45%, P = 0.003). Current smokers who made use of snus smoked on average fewer cigarettes per day than non‐users of snus. The mean duration of abstinence among former smokers was not influenced by snus use. Conditionally on age, education and use of nicotine replacement therapy there was an increased probability of being a former rather than a current smoker with ever use (OR 1.72, 95% CI = 1.30–2.28) or current use (OR 1.81, 95% CI = 1.31–2.53) of snus. Having used snus at the latest quit attempt increased the probability of being abstinent by about 50% (OR 1.54, 95% CI = 1.09–2.20). Conclusions Our study suggests that by using snus, Swedish male smokers may increase their overall chances of abstinence. However, 71% of the men in this sample who quit smoking did so without using snus and the duration of abstinence was not affected by snus use. This suggests that snus is not a necessary component of smoking cessation at the population level. Snus use was very rare among women.     

Ability of smokers to reduce their smoking and its association with future smoking cessation

Aims. We examined whether cigarette smokers in the United States can significantly reduce their smoking and maintain this reduction and, if so, whether this predicts an increase or decrease in the probability of smoking cessation in the future. Design. Longitudinal observation study. Setting. The 22 US cities of the Community Intervention Trial for smoking cessation (COMMIT). Participants. The 1410 subjects who smoked at both baseline and at 2-year follow-up. Intervention. Public health efforts to prompt cessation in half the communities. Measurements. Self-reported cigarettes/day and abstinence at baseline, 2-year and 4-year follow-ups. Findings. At 2-year follow-up. 60% of the subjects had either not changed or increased their smoking, 17% had decreased their smoking by 5-25%, 15% by 24-49% and 8% by 50%. Among the 40% who had reduced 5% at 2-year follow-up, 52% reported maintaining that reduction at 4-year follow-up. Reduction in smoking at year 2 did not prospectively predict an increase or decrease in the probability of making a quit attempt; nor did it predict eventually quitting by year 4. Conclusions. A substantial minority of US smokers are able to reduce their smoking and maintain this for long periods of time. Smoking reduction neither promotes nor undermines cessation.     

Influence of traditional tobacco use on smoking cessation among American Indians

Aims To examine the influence of traditional tobacco use on smoking cessation among American Indian adult smokers. Design, setting and participants A cross‐sectional survey of self‐identified American Indians was conducted from 2008 to 2009. A total of 998 American Indian adults (18 years and older) from the Midwest participated in the study. Measurements Traditional tobacco use and method of traditional use were both assessed. Commercial tobacco use (current smoking) was obtained through self‐reported information as well as the length of their most recent quit attempt. We also assessed knowledge and awareness of pharmacotherapy for current smokers. Findings Among participants in our study, 33.3% were current smokers and they reported smoking an average of 10 cigarettes per day. American Indian current smokers who used traditional tobacco reported a greater number of days abstinent during their last quit attempt compared to those who do not use traditional tobacco (P = 0.01). However, it appears that this protective effect of traditional tobacco use is diminished if the person smokes traditional tobacco. Finally, very few (fewer than 20% of current smokers) were aware of more recent forms of pharmacotherapy such as Chantix or bupropion. Conclusions American Indians appear to show low levels of awareness of effective pharmacotherapies to aid smoking cessation, but those who use ‘traditional tobacco’ report somewhat longer periods of abstinence from past quit attempts.     

Smoking cessation patterns and predictors of quitting smoking among the Japanese general population: a 1-year follow-up study

Aim   To examine the percentage of Japanese adult smokers who make quit attempts and succeed in smoking cessation over a 1-year period, and to identify predictors of attempts to stop and successful smoking cessation.
Design and setting   This study used Ipsos JSR Company's access panel, whose sampling framework is based on the Basic Resident Register in Japan. We tracked and monitored a selected sample of smokers who were at least 20 years of age through a baseline postal questionnaire survey in 2005 and a follow-up survey 1 year later.
Participants   The original response rate was 72.1% (1874 of 2600 smokers). There were 1627 current smokers in the baseline survey, and of those, 1358 were followed-up 1 year later.
Findings   Among the current smokers, 23.0% reported that they had attempted to quit smoking at least once in the past year. Of those who made quit attempts, 25.6% had achieved 1-week abstinence successfully and 13.5% reported having achieved sustained 6-month abstinence successfully at the time of the follow-up survey. The predictors associated with quit attempts were non-daily smoker, higher motivation to quit and previous attempts to stop smoking. Among smokers who made quit attempts, only 13.5% used nicotine replacement therapy. Higher nicotine dependence was associated with lower probability of success in quitting.
Conclusions   Japanese smokers attempt to quit at a lower rate than smokers in the United Kingdom and United States, but factors that predict attempts (primarily markers of motivation) and success of attempts (primarily dependence) are similar to those found in western samples.     

Long‐term effects of a preoperative smoking cessation programme

Introduction: Preoperative smoking intervention programmes reduce post‐operative complications in smokers. Little is known about the long‐term effect upon smoking cessation. Aim: To discover long‐term quit rates and the reasons behind successful cessation. Materials and Methods: 101 one of 120 smokers, randomised to smoking intervention or no intervention before hip and knee surgery, completed questionnaires concerning smoking after 1 year. We selected representative men and women for focus group interviews. Results: Significantly more patients from the intervention group abstained from smoking for 1 year post‐operatively [13 in 60 patients (22%) vs 2 in 60 (3%), P < 0.01]. Sex (male), low nicotine dependency, non‐smoking spouse and preoperative smoking intervention were related to smoking cessation. All patients gave the same reasons for smoking cessation: improved health and saving money. Follow‐up for 5 years showed 17% of the controls and 8% in the intervention group (P = 0.42) had died. Conclusion: The intervention group had a significantly higher quit rate 1 year after a preoperative smoking cessation programme. Please cite this paper as: Villebro NM, Pedersen T, Møller AM and Tønnesen H. Long‐term effects of a preoperative smoking cessation programme. The Clinical Respiratory Journal 2008; 2: 175–182.     

Healthcare provider intervention on smoking and quit attempts among HIV-positive versus HIV-negative MSM smokers in Chengdu,China

Given the implications for smoking among HIV-positive individuals and high smoking and HIV rates among men who have sex with men (MSM) in China, we examined sociodemographic, smoking-related, psychosocial, and substance use factors in relation to HIV status; receiving some sort of healthcare provider intervention regarding smoking; and having made a quit attempt in the past year in a sample of MSM smokers in Chengdu. We conducted a cross-sectional survey of 381 MSM smokers recruited by a nongovernmental organization in Chengdu in 2012–2013. Of these, 350 disclosed their HIV status and 344 (188 HIV-positive and 156 HIV-negative) provided completed data. Half (50.0%) reported at least one quit attempt in their lifetime; 30.5% reported a quit attempt in the past year. The majority (59.4%) reported that a healthcare provider had intervened in some way (assessed smoking, advised quitting, provided assistance), most commonly by assessing smoking status (50.0%). HIV-positive individuals were more likely to report a healthcare provider intervening on their smoking (p < .001). Those who received provider intervention were more likely to have attempted to quit ever (p = .009) and in the past year (p < .001). Those HIV-positive were more likely to have attempted to quit since diagnosis if a provider had intervened (p = .001). Multivariate regression documented that being HIV-positive (p < .001), greater cigarette consumption (p = .02), less frequent drinking (p = .03), and greater depressive symptoms (p = .003) were significant correlates of healthcare provider intervention. Multivariate regression also found that healthcare provider intervention (p = .003), older age (p = .01), and higher autonomous motivation (p = .007) were significant correlates of attempting to quit in the past year. Given the impact of healthcare provider intervention regarding smoking on quit attempts among MSM, greater training and support is needed to promote consistent intervention on smoking in the clinical setting among HIV-positive and HIV-negative MSM smokers.     

A randomized controlled trial of stage-matched intervention for smoking cessation in cardiac out-patients

Aim To examine the effectiveness of a stage‐matched smoking cessation counselling intervention for smokers who had cardiac diseases. Methods A total of 1860 Chinese cardiac patients who smoked at least one cigarette in the past 7 days and aged 18 years or above recruited from cardiac out‐patient clinics in Hong Kong hospitals were allocated randomly to an intervention group or control group. The intervention group (n = 938) received counselling matched with their stage of readiness to quit by trained counsellors at baseline, 1 week and 1 month. The control group (n = 922) received brief counselling on healthy diet at baseline. The primary outcomes were self‐reported 7‐day and 30‐day point prevalence (PP) of tobacco abstinence at 12 months after baseline. The secondary outcome measures included biochemically validated abstinence at 12‐month follow‐up, self‐reported 7‐day and 30‐day PP abstinence and reduction of cigarette consumption by 50% at 3 and 6 months. Results By intention‐to‐treat analysis, the intervention and control groups showed no significant difference in self‐reported 7‐day PP abstinence (intervention: 26.5% versus control: 25.5%; P = 0.60) and 30‐day PP (intervention: 25.4% versus control: 24.2%; P = 0.55), biochemically validated abstinence (intervention: 6.6% versus control: 4.9%; P = 0.14) and overall quit attempts of least 24 hours (intervention: 40.3% versus control: 34.3%; P = 0.007) at the 12‐month follow‐up, adjusted for the baseline stage of readiness to quit smoking. Conclusions An intervention, based on the Stages of Change model, to promote smoking cessation in cardiac patients in China failed to find any long‐term benefit.     

The role of desire, duty and intention in predicting attempts to quit smoking

Aims Motivation to quit smoking predicts quit attempts, although little is known about the role played by its different aspects. This study assessed the predictive value of desire, duty and intention to quit, three different aspects of motivation. Design A longitudinal study was conducted involving a nationally representative sample of smokers assessed at baseline and 3 and 6 months later. Baseline assessment took place by face‐to‐face computer‐assisted interviews; follow‐up assessments by postal questionnaires. Setting England. Participants From April 2008 to June 2009, a total of 5593 adult smokers were recruited; 1263 were followed‐up at 3 months and 1096 at 6 months. Measurements Three dichotomous measures of motivation to quit (wanting to quit, believing one ought to quit, intention to quit soon) were taken at baseline. Whether a subsequent quit attempt was made was recorded at 3‐ and 6‐month follow‐up. Findings More smokers believed they ought to quit smoking than wanted to or intended to soon (39.0, 29.3 and 23.5%, respectively). Desire and intention were independent predictors of quit attempts at both follow‐ups, whereas combining them did not add predictive value and duty was not a predictor. While the predictive value of desire or intention alone disappeared when accompanied by duty, their combination was robust against its negative effect. Conclusions Desire and intention independently positively predict quit attempts, while duty appears to mitigate their effect. It would be worth monitoring all three aspects of motivation when evaluating the impact of smoking cessation interventions on motivation to quit.     

'Closet' quit attempts: prevalence, correlates and association with outcome

Aims To examine the (i) prevalence, (ii) predictors and (iii) cessation outcomes of smokers who engage in undisclosed quit attempts. Design Online survey (n = 524), with balanced recruitment of current smokers (55%) and past‐year quitters (45%). Participants were daily smokers (current or previous) who had at least one quit attempt in the past year. Measurements Respondents were grouped on whether they did versus did not make advanced disclosure to others of their most recent quit attempt. Findings Almost half (n = 234; 45%) reported that their most recent quit attempt was undisclosed to anyone in advance. Those who planned their quit attempt in advance [odds ratio (OR) = 0.10; 95% confidence interval (CI): 0.05–0.23] and those who used behavioral treatment (OR = 0.14; 95% CI: 0.05–0.43) were less likely to make ‘closet quit attempts’, while those who rated their attempt as being serious (OR = 2.52; 95% CI: 1.16–5.46) and those who deemed social support to be unhelpful (OR = 1.91; 95% CI: 1.24–2.95) were more likely to make such attempts. Closet quit attempters were more likely to achieve 30 days of abstinence than were those who made advanced disclosure (67% versus 58%; adjusted OR 1.8; 95% CI: 1.1–2.8), but there were no differences for achieving 6 months of abstinence (52% versus 49%; adjusted OR 1.2; 95% CI: 0.7–2.0). Conclusions Attempting to quit smoking without telling anyone in advance is common, and does not appear to impede success. These findings do not support blanket advice to smokers to tell others about pending quit attempts.     

Impact of messages on concomitant use of nicotine replacement therapy and cigarettes: a randomized trial on the Internet

Aims To assess the impact of messages recommending the concomitant use of nicotine replacement therapy (NRT) and cigarettes on smokers’ intention to quit smoking. Design Randomized trial. Setting Internet. Participants A total of 2027 people who answered an e‐mail sent to 9074 current and former smokers recruited on a smoking cessation website. Intervention Participants were divided randomly into four groups, each of which received a unique message (in French) by e‐mail. The ‘control’ message said that nicotine replacement therapy (NRT) attenuates withdrawal symptoms in smokers who want to quit. The ‘temporary abstinence’ message added that NRT can also be used by current smokers to manage smoke‐free situations. The ‘reduction’ message indicated that NRT can be used by current smokers who do not want to quit but want to smoke fewer cigarettes. The ‘side‐effects’ message discouraged concomitant use of NRT and cigarettes. Measurements Perceived impact of these messages on motivation to quit smoking. Findings The e‐mail was answered by 2027 people (25% of 8124 valid addresses). Smokers who received the ‘reduction’ message were slightly more likely than controls to report that this message increased their motivation to quit (66% versus 60%, P = 0.02). In contrast, smokers who received the ‘side‐effects’ message were less likely than controls to report that this message increased their motivation (45% versus 60%, P < 0.001). The ‘temporary abstinence’ message had no detectable impact on motivation to quit. Conclusions Among smokers recruited via a smoking cessation website, messages encouraging concomitant use of NRT and cigarettes may have either no effect or a positive effect on motivation to quit smoking.     

Gender differences in the psychological determinants of cigarette smoking

Aims To compare the distributions of smoking‐related variables and the size of associations between these variables in men and women. Design and participants Mail survey in 2934 daily smokers (1533 women and 1401 men) who volunteered for a smoking cessation trial. Follow‐up after 7 months in 2456 people (84%). Setting Community setting (French‐speaking part of Switzerland, 1998). Findings Women smoked less than men (18 versus 22 cigarettes per day, p < 0.001), had lower confidence in their ability to refrain from smoking, used more frequently the strategy defined as ‘coping with the temptation to smoke’ and reported more drawbacks of smoking (gender differences ranged between 0.1 and 0.3 standard deviation units on these scales). There was no gender difference in the distribution of smokers by stage of change. At follow‐up, smoking cessation rates were similar in men and women (6% versus 5%, p = 0.3). Intention to quit, quit attempts in the previous year and a more frequent use of self‐change strategies predicted smoking cessation and were associated with tobacco dependence in both sexes. A more frequent use by women of coping strategies suggests that some women are ‘self‐restrained’ smokers who control their smoking permanently. This could explain lower smoking rates in women. The size of associations between smoking‐related variables was similar in men and women. Conclusions Even though there were gender differences in the distributions of some smoking‐related variables, associations between these variables were similar in men and women. This suggests that smoking behaviour is regulated by similar psychological mechanisms in men and women.     

Effects of sustained-release bupropion among persons interested in reducing but not quitting smoking

PURPOSE: To determine whether sustained-release bupropion promotes smoking reduction leading to smoking cessation among persons who wish to reduce their amount of smoking, but who are unwilling to quit or who perceive themselves as being unable to quit. METHODS: Current smokers were assigned randomly to receive either sustained-release bupropion (150 mg twice daily) or matching placebo. During an initial 6-month smoking reduction phase, those who were willing to quit entered a 7-week cessation phase, during which study medication was continued. RESULTS: Four-week continuous abstinence rates were 14% (41/295) in the bupropion group and 8% (25/299) in the placebo group (P = 0.02) during treatment. However, this benefit did not continue after treatment was stopped; subsequent continuous abstinence rates were 7% (20/295) in the bupropion group and 5% (16/299) in the placebo group (P = 0.50). Similar proportions of subjects entered the cessation phase in both treatment groups (38% [n = 113] of those in the bupropion group and 34% [n = 101] of those in the placebo group), although the time until a cessation attempt was shorter for those taking bupropion (median, 64 days vs. 118 days, P = 0.008). The extent of smoking reduction (measured by urinary cotinine concentrations) among the 327 subjects who did not enter the cessation phase was significantly greater (P <0.05) in those treated with bupropion during the reduction treatment phase, but not during the month 12 follow-up visit (P = 0.25). CONCLUSION: Sustained-release bupropion, when used in smokers initially not willing to make a cessation attempt, can help sustain smoking reduction while subjects are on active medication, reduce the time until the next cessation attempt, and increase short-term abstinence rates. However, these benefits were modest and not sustained after bupropion was discontinued.     

An Ecological Momentary Assessment analysis of relations among coping, affect and smoking during a quit attempt

Aims This study used Ecological Momentary Assessment (EMA) data from smokers trying to quit to assess relations among coping, positive affect, negative affect and smoking. The effects of stress coping on affect and smoking were examined. Design Data from a randomized clinical trial of smoking cessation treatments were submitted to multi‐level modeling to test the effects of coping with stressful events on subsequent affect and smoking. Setting Center for Tobacco Research and Intervention, Madison, Wisconsin. Participants A total of 372 adult daily smokers who reported at least one stressful event and coping episode and provided post‐quit data. Measurements Participants' smoking, coping and affect were assessed in near real time with multiple EMA reports using electronic diaries pre‐ and post‐quit. Findings Multi‐level models indicated that a single coping episode did not predict a change in smoking risk over the next 4 or 48 hours, but coping in men was associated with concurrent reports of increased smoking. Coping predicted improved positive and negative affect reported within 4 hours of coping, but these affective gains did not predict reduced likelihood of later smoking. Pre‐quit coping frequency and gender moderated post‐quit stress coping relations with later positive affect. Men and those with greater pre‐quit coping frequency reported greater gains in positive affect following post‐quit coping. Conclusions Coping responses early in a quit attempt may help smokers trying to quit feel better, but may not help them stay smoke‐free.