Smoker Characteristics and Smoking-Cessation Milestones

Abstract

Background Contextual variables often predict long-term abstinence, but little is known about how these variables exert their effects. These variables could influence abstinence by affecting the ability to quit at all, or by altering risk of lapsing, or progressing from a lapse to relapse. Purpose To examine the effect of common predictors of smoking-cessation failure on smoking-cessation processes. Methods The current study (N = 1504, 58% female, 84% Caucasian; recruited from January 2005 to June 2007; data analyzed in 2009) uses the approach advocated by Shiffman et al., (2006), which measures cessation outcomes on three different cessation milestones (achieving initial abstinence, lapse risk, and the lapse-relapse transition) to examine relationships of smoker characteristics (dependence, contextual and demographic factors) with smoking-cessation process. Results High nicotine dependence strongly predicted all milestones: not achieving initial abstinence, and a higher risk of both lapse and transitioning from lapse to complete relapse. Numerous contextual and demographic variables were associated with higher initial cessation rates and/or decreased lapse risk at 6 months post-quit (e.g., ethnicity, gender, marital status, education, smoking in the workplace, number of smokers in the social network, and number of supportive others). However, aside from nicotine dependence, only gender significantly predicted the risk of transition from lapse to relapse. Conclusions These findings demonstrate that: (1) higher nicotine dependence predicted worse outcomes across every cessation milestone; (2) demographic and contextual variables are generally associated with initial abstinence rates and lapse risk and not the lapse-relapse transition. These results identify groups who are at risk for failure at specific stages of the smoking-cessation process, and this may have implications for treatment.

Time-Varying Processes Involved in Smoking Lapse in a Randomized Trial of Smoking Cessation Therapies

“…We found that baseline dependence and momentary craving and negative affect all predicted smoking after quit attempt, but this association differed across the 2 weeks after a quit attempt. Although prior work using more traditional methods (Berkman et al, 2011;Japuntich et al, 2011;Piasecki et al, 2000;Shiffman & Waters, 2004;Zhou et al, 2009) has identified these factors as predictors of lapse, this study showed periods when they were more strongly or weakly associated with smoking. This difference is represented by our series of analyses; for example, in the MLM, a 1 SD increase in baseline dependence was associated with 1.28 greater odds of smoking; in the TVEM, the association varied over time from a high of 1.4 greater odds early in the quit attempt to no effect in the second week.…”

“…In addition to predicting longer term relapse, increases in smoking urges or cravings and negative affect are associated with immediate smoking lapses (Berkman et al, 2011;Shiffman & Waters, 2004). Baseline nicotine dependence is associated with smoking relapse, with stronger nicotine addiction predicting relapse (Japuntich et al, 2011;Piasecki et al, 2000;Zhou et al, 2009). However, although research has demonstrated the importance of smoking urges, negative affect, and baseline dependence on lapse and relapse, prior research has not examined time-varying associations: for example, whether particular factors are more strongly associated with smoking early versus later in a quit attempt.…”

“…When these pharmacotherapies were compared in a head to head study, the combination therapy of nicotine patch plus nicotine lozenge was the most efficacious relative to placebo . However, most studies of these therapies focus on longer term abstinence, and little is known about the process by which they may work to prevent initial lapses or particular periods in which they may be more effective (although cf., Japuntich et al, 2011).…”

Which measures of cigarette dependence are predictors of smoking cessation during pregnancy? Analysis of data from a randomized controlled trial

“…Cigarette dependence measures have been shown to be valid in non‐pregnant smokers 23, 24, 25, 26, 27, but little is known about their validity for predicting smoking cessation in pregnancy. For example, among pregnant smokers the odds of cessation have been related inversely to baseline cotinine level 24, and in another study 29 scores for Fagerström Test of Cigarette Dependence (FTCD), urges to smoke and withdrawal symptoms failed to predict smoking status 2 weeks following the quit date.…”

Treatment for Tobacco Dependence: Effect on Brain Nicotinic Acetylcholine Receptor Density

“…The most replicated predictor of smoking cessation outcome is severity of dependence on cigarettes, which includes number of cigarettes per day (Batra et al, 2008;Dale et al, 2001;Hymowitz et al, 1997;Japuntich et al, 2011;Kozlowski et al, 1994;Paluck et al, 2006;Westman et al, 1997). Greater severity of dependence has been associated with poorer outcome for group psychotherapy (Kozlowski et al, 1994), bupropion HCl (Dale et al, 2001;Paluck et al, 2006), and nicotine patch (Batra et al, 2008;Westman et al, 1997), as well as in naturalistic settings with no specific treatment (Hymowitz et al, 1997).…”