A tailored behavioral intervention did not increase quit rates over patch and minimal treatment. Smoking cessation rates in methadone-maintained smokers are low, with men having greater success.
Introduction: Many smokers reduce their cigarette consumption during failed attempts to quit. We report the impact of changes in consumption on smoking‐related respiratory symptom severity (SRRSS).
Methods: Between February 2002 and May 2004 we recruited 383 smokers from 5 methadone maintenance programs for a randomized trial of nicotine replacement plus behavioral treatment versus nicotine replacement alone for smoking cessation. Cigarette use in the 28 days prior to the interview, and severity of SRRSS using a 7‐item respiratory index, were assessed at baseline and at 3‐month follow‐up.
Outcome: Baseline minus 3‐month assessment difference in SRRSS score.
Results: Follow‐up of 319 participants (83.3%), mean age 40.4 years, 51.4% male, who smoked 26.4 cigarettes per day, demonstrated a mean reduction of 16.7 cigarettes per day. A reduction in cigarette use was positively and significantly (b=0.29, t=5.16, P<.001) associated with a reduction in smoking‐related symptom severity after adjusting for age, gender, race, years of regular smoking, baseline nicotine dependence, and history of treatment for asthma or emphysema. A 1 standard deviation reduction in average daily smoking (about 14.1 cigarettes) was associated with a 0.28 standard deviation decrease in smoking‐related symptom severity.
Conclusion: Reduction in symptom severity increases as absolute reduction in daily smoking increases. This is the first study to demonstrate an association between subjective short‐term health changes and reduction in smoking.
The association of depression and successful smoking cessation efforts is inconsistent. We test the hypothesis that higher levels of depression complicate efforts to quit smoking in a methadone-maintained (MM) population offered nicotine replacement and a brief behavioral intervention. We recruited 383 participants from 2/02 to 5/04; 340 (88.8%) were assessed at follow- up. Current depressive symptoms were measured using the Psychiatric Diagnostic Screening Questionnaire (PDSQ). Participants were 53% male, 78% Caucasian, with a mean MM duration of 153 weeks. Twenty-seven percent met PDSQ screening criteria for Major Depressive Disorder (MDD). Participants with higher levels of depressive symptoms were significantly less likely to set a quit date (p = .02) but depression was not associated significantly with motivation to quit smoking at baseline, time to first cigarette, or any behavioral indicator of smoking during the follow-up period. Depressive symptoms have little influence on smoking cessation outcomes in this population.
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