Factors associated with outcome in unaided smoking cessation, and a comparison of those who have never tried to stop with those who have.

AIM. This survey set out to determine the factors associated with outcome of unaided smoking cessation attempts and to compare the characteristics of smokers who had tried to stop with those who had never tried. METHOD. A postal questionnaire was sent to a random sample of 2000 adults in Aberdeen, Scotland. Those respondents who smoked or who were ex-smokers were sent a second questionnaire. The outcome measure for success in trying to stop smoking was abstinence for more than four months. RESULTS. Light and heavy smokers were more successful at smoking cessation than moderate smokers. Those who succeeded perceived that they had more social support than failures, and were more likely to have 'simply just stopped'. They were less likely to have used nicotine gum or to believe that smoking was harmful. Those who failed experienced more withdrawal symptoms, and were more likely to be tempted by the presence of others smoking. Eleven per cent of smokers had never tried to stop. These smokers were older and more dependent than those who had tried to stop. They were less likely to acknowledge the health risks of smoking or to conform to social pressures, but were more likely to consider stopping for financial reasons alone. CONCLUSION. Heavily dependent smokers may fare better in unaided cessation than the results of clinic-based research suggest. For those who have tried to stop, increasing motivation and social support, and minimizing withdrawal symptoms, may be more productive than further emphasis on health risks. Motivating smokers who have not previously tried to stop may involve more emphasis on the health risks of smoking and the health benefits of stopping, as well as on other non-financial benefits of stopping such as social acceptability. Fiscal measures may be particularly effective in motivating this group of smokers to try to stop.     

Factors influencing success in counseling patients to stop smoking

This study examined the anti-smoking counseling practices of a group of family practice physicians and related these to success in persuading patients to stop smoking. The study population included 283 cigarette smoking patients of 28 family practice residents. Patients were followed over a 3-month period to assess changes in smoking behavior. Two measures of success in counseling patients to stop smoking were evaluated in the study: (1) the percentage of a physician's patients who tried to quit smoking, and (2) the percentage of a physician's patients who succeeded in quitting. Findings showed wide variation among physicians in the percentage of patients who tried to quit (range: 20%–77%) and the percentage of patients who succeeded in quitting (range: 0%–25%). Two counseling practices, advising patients to set a target date for quitting and scheduling follow-up visits with patients to monitor progress, were related to the percentage of a physician's patients who quit smoking. These two counseling practices represent a way of structuring the patients quitting effort and committing the patient to follow through with a decision to stop smoking, both of which appear to be key ingredients to success in counseling patients to stop smoking.     

Perceived barriers to and benefits of attending a stop smoking course during pregnancy

OBJECTIVE: During pregnancy, the uptake of smoking cessation courses is very low. We assessed perceived barriers to and benefits of attending a cessation course during pregnancy. METHODS: A decisional-balance questionnaire was devised, including 10 statements reflecting benefits of attending a cessation course and 10 statements of barriers to attendance. The questionnaire was delivered via the Internet and targeted pregnant smokers/recent ex-smokers. Participants completed the questionnaire on a single occasion, indicating their agreement with each statement. RESULTS: Among 443 respondents, the most frequently endorsed barriers were 'Being afraid of disappointing myself if I failed' (54%) and not tending to seek help for this sort of thing (41%). The most frequently endorsed benefits were advice about cigarette cravings (74%) and praise and encouragement with quitting (71%). A greater interest in receiving help with quitting from a counselor was significantly associated with: being older, lower income, husband/partner advising cessation and less confidence in quitting. CONCLUSION: Pregnant smokers perceive many benefits of smoking cessation courses. However, these women also perceive many barriers to attendance and studies are needed to evaluate interventions for overcoming such barriers. PRACTICE IMPLICATIONS: Smoking cessation services need to address the perceived barriers to attending stop smoking courses during pregnancy, to publicise the benefits of these courses and to target women who feel that they cannot quit without this type of support.     

Genetic influence on smoking--a study of male twins.

BACKGROUND. The results of twin and family studies suggest that heredity has a small influence on smoking behavior. METHODS. We conducted a genetic analysis of several aspects of smoking behavior among subjects in the National Academy of Sciences-National Research Council Twin Registry. The registry includes male twins who were born in the United States between 1917 and 1927 and who were members of the armed services during World War II. Information on smoking history was available for 4775 pairs of twins, who were first surveyed in 1967 through 1969, when they were 40 to 50 years old, and then re-surveyed in 1983 through 1985, when they were 56 to 66. Eighty percent of the subjects in this cohort had smoked at some time in their lives, 60 percent were smokers in 1967 through 1969, and 39 percent were smoking in 1983 through 1985. Similarities between twins in smoking habits at base line and at the second follow-up 16 years later were examined. The comparison of concordance for smoking between monozygotic and dizygotic twins was used to assess the relative contribution of familial and genetic factors. RESULTS. In 1967-1969 survey the ratio of observed to expected concordance for smoking was higher among the monozygotic twins than among the dizygotic twins for those who had never smoked (overall rate ratio, 1.38; 95 percent confidence interval, 1.25 to 1.54), for former smokers (overall rate ratio, 1.59; 95 percent confidence interval, 1.35 to 1.85), for current cigarette smokers (overall rate ratio, 1.18; 95 percent confidence interval, 1.11 to 1.26), and for current cigar or pipe smokers (overall rate ratio, 1.60; 95 percent confidence interval, 1.22 to 2.06). The data also suggest genetic influences on quitting smoking. Monozygotic twins were more likely than dizygotic twins to be concordant for quitting smoking (overall rate ratio, 1.24; 95 percent confidence interval, 1.06 to 1.45). CONCLUSIONS. In this cohort of adult male twins, there were moderate genetic influences on lifetime smoking practices.     

Understanding the effects of fear-arousing communications: The role of cognitive factors and amount of fear aroused

This paper reports an experimental study investigating the role of cognitive factors and fear in mediating the effects of fear-arousing health threat communications. Seventy-seven cigarette smokers were shown either a videotape about smoking or a control videotape on a different health topic before completing a questionnaire assessing their intentions to try to quit, the level of fear aroused, and three cognitive factors: (a) probability difference (perceived reduction in risk of health damage that follows from successful cessation), (b) utility of health damage, and (c) confidence. The smoking videotape influenced probability difference, utility, intentions, and follow-up reports of attempts at cessation. As predicted, both probability difference and utility influenced intention, which in turn influenced behavior. Neither confidence nor the amount of fear aroused by the videotape had significant effects on intention.The Medical Research Council, London, England, provided financial support.     

Smoking and quitting among Irish teenage males

Nicotine addiction in adulthood is usually preceded by exposure to cigarettes in adolescence. A minimal exposure may be sufficient to produce addiction. Strategies to reduce adult smoking must address those factors, which influence teenage smoking. In this study we aimed to establish the prevalence of smoking in male secondary schools, to measure the association between student's smoking status and parental, peer and sibling smoking and to describe attempted quitting. An anonymous questionnaire was given to 1070 male secondary school pupils in two schools in County Louth. Twenty-seven percent of respondents smoked every day or on most days. Having a best friend who smoked was associated with personal smoking (O.R. 11.75, C.I. 8.6-16.08) as was sibling smoking (O.R. 3.49, C.I. 2.67-4.57.) Seventy percent of smokers stated that they wanted to stop and 75% that they had tried to stop. Only five smokers (1.2%) had been advised to quit by their general practitioner. We conclude that smoking is as prevalent among teenage boys in Ireland as it has been shown to be elsewhere and that most teenagers are unable rather than unwilling to stop.     

Secular Versus Religious Norms Against Smoking: Which Is More Important as a Driver of Quitting Behaviour Among Muslim Malaysian and Buddhist Thai Smokers?

Background

This paper prospectively examined two kinds of social normative beliefs about smoking, secular versus religious norms.

Purpose

The purpose of this paper is to determine the relative importance of these beliefs in influencing quitting behaviour among Muslim Malaysian and Buddhist Thai smokers.

Methods

Data come from 2,166 Muslim Malaysian and 2,463 Buddhist Thai adult smokers who participated in the first three waves of the International Tobacco Control Southeast Asia project. Respondents were followed up about 18 months later with replenishment. Respondents were asked at baseline about whether their society disapproved of smoking and whether their religion discouraged smoking, and those recontacted at follow-up were asked about their quitting activity.

Results

Majority of both religious groups perceived that their religion discouraged smoking (78% Muslim Malaysians and 86% Buddhist Thais) but considerably more Buddhist Thais than Muslim Malaysians perceived that their society disapproved of smoking (80% versus 25%). Among Muslim Malaysians, religious, but not societal, norms had an independent effect on quit attempts. By contrast, among the Buddhist Thais, while both normative beliefs had an independent positive effect on quit attempts, the effect was greater for societal norms. The two kinds of normative beliefs, however, were unrelated to quit success among those who tried.

Conclusions

The findings suggest that religious norms about smoking may play a greater role than secular norms in driving behaviour change in an environment, like Malaysia where tobacco control has been relatively weak until more recently, but, in the context of a strong tobacco control environment like Thailand, secular norms about smoking become the dominant force.     

Smokers unlikely to quit

Data from a population survey were used to examine the relationships of the number and the duration of previous smoking cessation attempts with current confidence and perceived difficulty of quitting, beliefs about reasons for current smoking and for previous relapses, and preferences for different forms of assistance with cessation. There were significant positive relationships between the duration of previous cessation attempts and perceived difficulty and between the number of previous cessation attempts and confidence. Those who had made more cessation attempts and who had been able to abstain for less than a week were more likely to attribute both relapse and current smoking to uncontrollable factors such as addiction. There were no relationships between cessation attempts and preferences expressed for personalized, or any other, forms of assistance with cessation. These results support the proposition that multiple and short-duration smoking-cessation attempts are related to reduced optimism regarding future cessation.     

Reflections on the ex-smoker: Some findings on successful quitters

Following the lead of Schachter [(1982). Am. Psychol.37: 436–444] a questionnaire was developed to assess the process of self-cure among former cigarette smokers and then administered to 63 ex-smokers who had quit on their own. Separate samples of helped quitters and current smokers who had tried to quit but failed were also interviewed. Ex-smokers scored higher on Rosenbaum's [(1980). Behav. Ther.11: 109–121] Self-Control Schedule, which suggests that they may have succeeded because they had better self-control skills initially. Other results underscored the role of peer pressure and curiosity as major reasons for becoming a smoker, of withdrawal symptoms and loss of pleasure as major obstacles to quitting, and of self-confidence and perceived health benefits as factors that were most important in successful quitting.The difficulty associated with quitting was associated with cognitive factors such as beliefs about the addictive properties of nicotine and self-confidence ratings, as well as with a supportive social network and the amount smoked previously.     

A randomized controlled trial of the simple advice given by obstetricians in Guangzhou, China, to non-smoking pregnant women to help their husbands quit smoking

This is a randomized controlled trial to examine the effects of obstetrician's simple advice given to non-smoking pregnant women with the aim to help their husbands to give up smoking. Non-smoking pregnant women who were attending the Guangzhou Women and Children Health Care Centre and whose husbands were smokers were each randomised to an intervention (N = 380) or a control (N = 378) group. The members of the intervention group each received simple advice on encouraging their husbands to give up smoking and an educational booklet at their first antenatal visit, and reminders during subsequent visits, whereas the control group received none, as is the usual practice. Husbands' not smoking for 7 and for 30 days were the main outcomes of the study; other outcomes included husbands' attempts to stop and any decrease in the number of cigarettes smoked. These outcomes were assessed by means of a questionnaire responded to in the last month of pregnancy, which was subjected to 'intention-to-treat' analysis. Results show that more husbands in the intervention group had attempted to stop smoking (30.0% versus 22.2%; p = 0.02), reduced the number of cigarettes smoked (39.7% versus 17.7%; p < 0.0001), and had not smoked any cigarettes for the last 7 days before their wives completed the questionnaire (8.4% versus 4.8%; p = 0.04). The difference between groups in the number of husbands who had abstained from cigarettes for at least 30 days was not significant (6.1% versus 4.2%; p = 0.26). Obstetricians should consider incorporating advice on passive smoking into the antenatal programme for non-smoking pregnant women with smoking husbands.     

The effect of fear-arousing communications on cigarette smoking: An expectancy-value approach

This paper describes a model, derived from subjective expected utility ( SEU ) theory, which attempts to explain the effects of a fear-arousing communication about smoking and lung cancer on smokers' decisions to try to stop smoking. According to the model, the strength of the smoker's intention to try to stop smoking will depend on three factors: (1) the utility of lung cancer; (2) the perceived reduction in the risk of getting lung cancer that follows from successfully stopping smoking (probability difference); and (3) the subjective probability of successfully stopping smoking, or confidence. The usefulness of this model vis-á-vis one based on the amount of fear aroused by the communication was investigated in two experimental studies conducted in the field in which smokers watched either a videotape about smoking or one on a different health topic. The smoking videotape influenced not only attitudes and beliefs measured immediately after exposure but also subsequent self-reports of behavior (whether or not the subject tried to stop smoking or to cut down in the 3-month period following exposure to the videotape). In accordance with predictions, the three variables specified by the model together affected intention to try to stop smoking, which in turn affected behavior. The effect of confidence on intention was relatively large. There was no evidence for the multiplicative combination of utilities and subjective probabilities predicted by a strict SEU model. Contrary to the predictions of the model, but consistent with previous research, the amount of fear aroused by the videotape had an independent effect on intention, suggesting that explanations of the effects of fear-arousing communications will have to incorporate both cognitive and emotional mediation processes.     

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

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

Smoking cessation and severity of weight gain in a national cohort

BACKGROUND. Many believe that the prospect of weight gain discourages smokers from quitting. Accurate estimates of the weight gain related to the cessation of smoking in the general population are not available, however. METHODS. We related changes in body weight to changes in smoking status in adults 25 to 74 years of age who were weighed in the First National Health and Nutrition Examination Survey (NHANES I, 1971 to 1975) and then weighed a second time in the NHANES I Epidemiologic Follow-up Study (1982 to 1984). The cohort included continuing smokers (748 men and 1137 women) and those who had quit smoking for a year or more (409 men and 359 women). RESULTS. The mean weight gain attributable to the cessation of smoking, as adjusted for age, race, level of education, alcohol use, illnesses related to change in weight, base-line weight, and physical activity, was 2.8 kg in men and 3.8 kg in women. Major weight gain (greater than 13 kg) occurred in 9.8 percent of the men and 13.4 percent of the women who quit smoking. The relative risk of major weight gain in those who quit smoking (as compared with those who continued to smoke) was 8.1 (95 percent confidence interval, 4.4 to 14.9) in men and 5.8 (95 percent confidence interval, 3.7 to 9.1) in women, and it remained high regardless of the duration of cessation. For both sexes, blacks, people under the age of 55, and people who smoked 15 cigarettes or more per day were at higher risk of major weight gain after quitting smoking. Although at base line the smokers weighed less than those who had never smoked, they weighed nearly the same at follow-up. CONCLUSIONS. Major weight gain is strongly related to smoking cessation, but it occurs in only a minority of those who stop smoking. Weight gain is not likely to negate the health benefits of smoking cessation, but its cosmetic effects may interfere with attempts to quit. Effective methods of weight control are therefore needed for smokers trying to quit.     

Self-help quit smoking interventions: effects of self-help materials, social support instructions, and telephone counseling

Smokers requesting self-help materials for smoking cessation (N = 2,021) were randomized to receive (a) an experimental self-quitting guide emphasizing nicotine fading and other nonaversive behavioral strategies, (b) the same self-quitting guide with a support guide for the quitter's family and friends, (c) self-quitting and support guides along with four brief counselor calls, or (d) a control guide providing motivational and quit tips and referral to locally available guides and programs. Subjects were predominantly moderate to heavy smokers with a history of multiple previous quit attempts and treatments. Control subjects achieved quit rates similar to those of smokers using the experimental quitting guide, with fewer behavioral prequitting strategies and more outside treatments. Social support guides had no effect on perceived support for quitting or on 8- and 16-month quit rates. Telephone counseling increased adherence to the quitting protocol and quit rates.     

Predictors of smoking cessation and maintenance

A follow-up study of 263 volunteers who had completed a national smoking cessation program was conducted to measure the relative contribution of stress coping resources, smoking history, loci for health control, and certain demographic factors to the maintenance of smoking cessation. Stress coping resources and smoking history variables proved to be more predictive of the maintenance of abstinence than either perceived locus of control or demographic variables. Coping resources in the forms of perceived confidence, physical health, physical fitness, problem solving, self-directedness, and tension control were useful in predicting abstinence maintenance. Contrary to some earlier studies, no gender differences in relapse rates were found, and smoking a greater number of cigarettes daily and smoking cigarettes with a higher tar content were related to greater success in maintaining smoking abstinence. As was found in previous studies, the presence of other smokers in the household contributed to relapse. © 1998 John Wiley & Sons, Inc. J Clin Psychol 54: 223–235, 1998.     

Framing communication: Communicating the antismoking message effectively to all smokers

There is a need to effectively communicate the antismoking issue across all sectors of the community, particularly to smokers with no intentions to quit smoking. Information can be framed using positively or negatively focused language to communicate the message content with maximum effect. Current cigarette smokers, with and without intentions to quit smoking (N = 70), were asked to respond to a Quit Smoking message framed either positively (benefits of quitting) or negatively (costs of not quitting). Participants were assessed pre‐post message and at 3‐months follow‐up. Results obtained suggest message frames had differential effects on message processing and increasing smokers' self‐confidence to quit smoking. In particular, trends in results suggest smokers with and without intentions to quit smoking interacted differently to framed messages. These findings may facilitate the improvement of community‐based health communications, by encouraging the use of differential message frames to effectively communicate the antismoking information to encourage all smokers to stop smoking and discourage others from adopting the smoking behavior. © 2002 Wiley Periodicals, Inc.     

The Impact of Insurance Gain and Discussions with Healthcare Providers on Quitting Smoking

Tobacco use is the leading preventable cause of death in the United States. Analyzing the ability for different mechanisms to reduce smoking rates can provide healthcare systems with information to establish the most effective smoking cessation efforts. Health insurance provides individuals with direct mechanisms to curb smoking behavior, such as access to smoking cessation resources. Gaining insurance may additionally indirectly influence smoking cessation by altering risk perceptions. Behavioral economic theory suggests that gaining health insurance may reduce current smokers' rate of discounting on the future, which could increase smoking cessation. This article aimed to evaluate the impact of insurance status (i.e., gaining any private (n = 681), gaining only public (n = 647), or remaining uninsured (n = 5,056)) as well as the impact of having a discussion with a healthcare provider about quitting smoking on smoking cessation among current adult smokers who were uninsured at the beginning of their data collection. Data for this study came from the Medical Expenditure Panel Survey 2003 to 2014 database. The study found that while individuals gaining public insurance was not statistically associated with smoking cessation, individuals who gained private insurance were more likely to stop smoking than individuals who remained uninsured (OR: 1.330; 95% CI: 1.019,1.737; p = 0.036). Having a discussion with a healthcare provider about quitting smoking was not associated with smoking cessation. These findings indicate that gaining private insurance may impact smoking behavior through mechanisms other than direct access to physician services.     

Attitudes toward smoking cessation among men and women

Recent reports indicate that women are less successful than men in their attempts to quit smoking. Sex differences in attitudes toward smoking cessation were examined cross-sectionally in a sample of 447 smokers randomly selected from employees of 10 diverse Minnesota worksites and interviewed in early 1984. No sex differences were found in the percentage of smokers who had tried to quit at least once in the past; indeed, over four of five respondents reported prior attempts to quit. Yet compared to women, men were more interested in quitting. Women were less likely than men to perceive the health benefits of quitting and expressed more concern about weight gain and job pressures related to quitting. No significant sex differences were found in prior use of formal cessation services, which had been used by about one-fourth of these respondents. Yet compared to men, women appeared to rely on informal sources of support, such as encouragement from co-workers. These findings underline the importance of intervention programs targeting women and suggest strategies that might enhance the effectiveness of such programs oriented toward women.     

The Social, Genetic and Developmental Psychiatry Centre: its origins, conception and initial accomplishments

BACKGROUND: The Social, Genetic and Developmental Psychiatry Centre was established by the Medical Research Council, in partnership with the Institute of Psychiatry, King's College London, in 1994. METHOD AND RESULTS: The paper describes the origins of the Centre; the reasons why a new initiative was needed in the early 1990s; the thinking that led to the proposal for a major interdisciplinary research centre that integrated social, genetic and developmental research perspectives; the approach to international recruitment of world leaders; and the initial research accomplishments with respect to the basic goal of understanding nature-nurture interplay. CONCLUSIONS: The structure and interdisciplinary approach of the Centre have proved a success and the initial accomplishments have begun to meet the objectives of showing how nature-nurture interplay is involved in the development of psychiatric disorders.     

Smoking-Specific Experiential Avoidance is Indirectly Associated with Trait Worry and Smoking Processes among Treatment-Seeking Smokers

Limited work has examined worry, or apprehensive anticipation about future negative events, in terms of smoking. One potential explanatory factor is the tendency to respond inflexibly and with avoidance in the presence of smoking-related distress (smoking-specific experiential avoidance). Participants (n = 465) were treatment-seeking daily smokers. Cross-sectional (pre-treatment) self-report data were utilized to assess trait worry, smoking-specific experiential avoidance, and four smoking criterion variables: nicotine dependence, motivational aspects of quitting, perceived barriers to smoking cessation, and severity of problematic symptoms reported in past quit attempts. Trait worry was significantly associated with greater levels of nicotine dependence, motivation to quit smoking, perceived barriers for smoking cessation, and more severe problems while quitting in the past; associations occurred indirectly through higher levels of smoking-specific experiential avoidance. Findings provide initial support for the potential role of smoking-specific experiential avoidance in explaining the association between trait worry and a variety of smoking processes.