Motivations for smoking cessation: a comparison of successful quitters and failures

Motivations for continued tobacco smoking and reasons for quitting among youths in Wakiso district, Uganda: a qualitative study

BACKGROUND

Efforts have been invested towards cessation of tobacco use among youths aged 18-35 years, however, motivators for continued tobacco smoking and reasons for quitting are limited in Ugandan settings. Therefore, this study aimed to explore motivations for continued tobacco smoking and reasons for quitting in Wakiso district Uganda.

METHODS

This study used explanatory sequential method. Data from a Population-based survey collected from October 2019 to September 2020 was used to select participants for this qualitative study. Twenty-three in-depths interviews were conducted from July to October 2021 among youths (18-35years old) who reported continued tobacco use and those who quit. Data were analyzed using a team-based thematic content approach with the help of NVivo.

RESULTS

Data was collected from a total of twenty three participants, fourteen were tobacco quitters and nine were current tobacco smokers. Recurrent habit, desire to complement the use of other drugs, peer pressure, using smoking as a replacement for alcohol consumption, low tobacco prices, smoking as a tradition were reported as motivators for continued tobacco smoking. However, reported reasons for quitting smoking by youths included; packaging health warnings, school based prevention programs, fear of associated health risks due to tobacco use, embarrassment from family members.

CONCLUSION

Targeted, and tailored tobacco prevention counselling through family support programs, intensified health education on the risks of smoking, and implementing stronger health warnings on tobacco packaging can be employed to reduce or stop tobacco use among urban youth.

A Qualitative Examination of Tobacco Use and Smoking Cessation Among Gender Minority Adults

BACKGROUND

Despite the elevated prevalence of smoking among gender minority adults, little is known about the factors that influence their tobacco use and cessation.

PURPOSE

We identified and examined factors that influence tobacco use and cessation for gender minority adults, using a conceptual framework based on the Model of Gender Affirmation and Gender Minority Stress Model.

METHODS

Nineteen qualitative, semi-structured in-depth interviews were conducted with gender minority adults who smoke or no longer smoke and were recruited from the Portland, OR metropolitan area. Interviews were audio-recorded, professionally transcribed, and analyzed utilizing thematic analysis.

RESULTS

Four main themes were generated. Gender minority adults smoke to cope with general and gender minority-specific stressors. Smoking was described as a social behavior that was influenced and sustained by community and interpersonal relationships. Smoking cessation was motivated by health concerns (both general and gender minority-specific) and moderated by conducive life circumstances. Recommendations for tobacco cessation interventions highlighted the importance and role of social support. Participants expressed a strong desire for gender minority-specific tobacco cessation programs. There are unique and complex factors that contribute to the higher prevalence of smoking observed among gender minority adults.

CONCLUSIONS

Tobacco cessation interventions are urgently needed for this population and should be tailored to address the unique factors that impact tobacco use and cessation among gender minority people to increase the likelihood of success.

Factors Associated With Obtaining Lung Cancer Screening Among Persons Who Smoke

Background. Screening with low-dose computed tomography scans can reduce lung cancer deaths but uptake remains low. This study examines psychosocial factors associated with obtaining lung cancer screening (LCS) among individuals. Methods. This is a secondary analysis of a randomized clinical trial conducted with 13 state quitlines’ clients. Participants who met age and smoking history criteria were enrolled and followed-up for 6 months. Only participants randomized to the intervention group (a patient decision aid) were included in this analysis. A logistic regression was performed to identify determinants of obtaining LCS 6 months after the intervention. Results. There were 204 participants included in this study. Regarding individual attitudes, high and moderate levels of concern about overdiagnosis were associated with a decreased likelihood of obtaining LCS compared with lower levels of concern (high levels of concern, odds ratio [OR] 0.17, 95% confidence interval [CI] 0.04–0.65; moderate levels of concern, OR 0.15, 95% CI 0.05–0.53). In contrast, higher levels of anticipated regret about not obtaining LCS and later being diagnosed with lung cancer were associated with an increased likelihood of being screened compared with lower levels of anticipated regret (OR 5.59, 95% CI 1.72–18.10). Other potential harms related to LCS were not significant. Limitations. Follow-up may not have been long enough for all individuals who wished to be screened to complete the scan. Additionally, participants may have been more health motivated due to recruitment via tobacco quitlines. Conclusions. Anticipated regret about not obtaining screening is associated with screening behavior, whereas concern about overdiagnosis is associated with decreased likelihood of LCS. Implications. Decision support research may benefit from further examining anticipated regret in screening decisions. Additional training and information may be helpful to address concerns regarding overdiagnosis.

Factors Correlated with Smoking Cessation Success in Older Adults: A Retrospective Cohort Study in Taiwan

Smoking cessation in the elderly is very important. This study aims to explore the success rate of smoking cessation in the elderly and the factors that predict the success of smoking cessation. We collected data from smokers ≥60 years who visited a medical center in Taiwan during 2017. All patients were prescribed either varenicline or nicotine replacement therapy (NRT) for smoking cessation. The participants were asked about their smoking status after treatment. In total, 129 participants were enrolled. The three- or six-month point abstinence rate was 48.1%. No significant difference was found among baseline characteristics (including age, gender, underlying diseases, smoking duration, daily consumption amount of cigarette, carbon monoxide concentration, Fagerström test for nicotine dependence scores, and treatment method) between quitters and non-quitters, except for the type of medication used. The proportion of quitters using varenicline was significantly higher than that of non-quitters. Multivariate regression analyses showed that the patients who received varenicline were 3.22 times more likely to quit smoking than those who received NRT. Therefore, we suggest that varenicline use may help in smoking cessation in older adults, compared to NRT. Other baseline characteristics may not affect the success rate of smoking cessation in this population.

What Differentiates Underserved Smokers Who Successfully Quit From Those Who Do Not

Poor persons continue to smoke at high rates and suffer grave health effects. We have been working with our community partners since 2008 to help poor people in the surrounding neighborhoods stop smoking through a multi-phase CBPR intervention known as CEASE. Our study used qualitative methods to identify factors that characterized those who successfully quit smoking (doers) and those who did not (non-doers). Both doers and non-doers identified social pressure as the main reason for starting to smoke, and health as the main motivator for quitting. Although they were similar in many ways, the doers seemed to have more social support for cessation-i.e., more people in their lives who wanted them to quit and whom they wanted to protect from secondhand smoke. The non-doers offered more feedback on how to improve the cessation classes, including making them longer, reducing the class size, adding extra counseling, and using quitting partners. Both doers and non-doers reported increased self-confidence, appreciation for the cessation support they received from CEASE, and a desire that the group classes continue. Cessation is a social event and smokers with more social support appear to be more successful at quitting. Showing interest in and offering social support to poor underserved smokers in their own communities is a powerful way to help them.

Physical Activity and Quit Motivation Moderators of Adolescent Smoking Reduction

OBJECTIVES

We examined participant characteristics as moderators of adolescents' smoking cessation outcomes as a function of intervention: Not-on-Tobacco (N-O-T), N-O-T with a physical activity (PA) module (N-O-T+FIT), or Brief Intervention (BI).

METHODS

We randomly assigned youth (N = 232) recruited from public high schools to an intervention, and measured their baseline levels of PA and motivation to quit. The number of cigarettes/day for weekdays and weekends was obtained at baseline and 3-month follow-up.

RESULTS

Across timepoints, cigarette use declined for youth in N-O-T (p = .007) and N-O-T+FIT (ps < .02), but not BI (n.s.). For N-O-T+FIT youth, the steepest declines in weekday smoking occurred for those with high PA levels (p = .02). Weekend cigarette use decreased for N-O-T+FIT youth with moderate-high levels of intrinsic motivation to quit (ps < .04).

CONCLUSIONS

Adolescents may benefit from interventions designed to address the barriers faced during a quit attempt, including their motivation to make a change and their engagement in other healthy behaviors such as physical activity.

Adult attention-deficit/hyperactivity disorder and nicotine withdrawal: a qualitative study of patient perceptions

BACKGROUND

Nicotine use has been reported to ameliorate symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD). Furthermore, adults with ADHD have a relatively high prevalence of cigarette smoking and greater difficulty abstaining from smoking. Overall, though, there is scant literature investigating the beliefs, perceptions and experiences of smokers with ADHD regarding smoking cessation and withdrawal.

METHODS

Our participants (n = 20) fulfilling criteria for ADHD and a past or current dependence from nicotine were recruited from the in- and outpatient clinic of the Zurich University Psychiatric Hospital and the Psychiatric Services Aargau (Switzerland). We conducted in-depth interviews to explore their motivations to quit, past experiences with and expectations about quitting using a purposeful sampling plan. The sample was selected to provide diversity in relation to level of nicotine dependence, participation in a smoking-cessation program, gender, age, martial status and social class. Mayring's qualitative content analysis approach was used to evaluate findings.

RESULTS

Adult smokers with ADHD had made several attempts to quit, experienced intense withdrawal symptoms, and relapsed early and often. They also often perceived a worsening of ADHD symptoms with nicotine abstinence. We identified three motives to quit smoking: 1) health concerns, 2) the feeling of being addicted, and 3) social factors. Most participants favored a smoking cessation program specifically designed for individuals with ADHD because they thought ADHD complicated their nicotine withdrawal and that an ADHD-specific smoking cessation program should address specific symptoms of this disorder.

CONCLUSIONS

Since treatment initiation and adherence associate closely with perception, we hope these findings will result in better cessation interventions for the vulnerable subgroup of smokers with ADHD.

Evaluating the role of anxiety sensitivity in barriers to cessation and reasons for quitting among smokers with asthma

The aim of the present study was to examine the unique predictive ability of anxiety sensitivity (AS) in terms of perceived barriers to cessation and smoking cessation motives among daily smokers with asthma (n = 125, 54% male, Mage = 37.7 years, SD = 12.1). As hypothesized, after controlling for the effects of race, asthma control, negative affect, and smoking rate, AS significantly predicted greater barriers to cessation, and reasons for quitting related to health concerns and self-control. Contrary to hypotheses, AS did not significantly predict external reasons for quitting. These findings suggest that smokers with asthma who are fearful of physiological arousal may be a particularly 'at-risk' population for smoking cessation difficulties due, in part, to greater perceived barriers to cessation. Interventions focused on enhancing intrinsic motivation for quitting and reducing AS may be most effective for this population.

Relationships among factual and perceived knowledge of harms of waterpipe tobacco, perceived risk, and desire to quit among college users

Waterpipe tobacco smoking is increasing in the United States among college students. Through a web-based survey, we explored associations among factual and perceived knowledge, perceived risks and worry about harm and addiction, and desire to quit among 316 college waterpipe tobacco smoking users. Overall, factual knowledge of the harm of waterpipe tobacco smoking was poor, factual and perceived knowledge was weakly correlated, both forms of knowledge were related inconsistently to perceived risks and worry, and neither form of knowledge was associated with the desire to quit. Findings provide preliminary insights as to why knowledge gaps may not predict cessation among waterpipe users.

Lung cancer stem cells: Molecular features and therapeutic targets

Lung cancers are highly heterogeneous and resistant to available therapeutic agents, with a five year survival rate of less than 15%. Despite significant advances in our knowledge of the genetic alterations and aberrations in signaling pathways, it has been difficult to determine the basis of lung cancer heterogeneity and drug resistance. Cancer stem cell model has attracted a significant amount of attention in recent years as a viable explanation for the heterogeneity, drug resistance, dormancy and recurrence and metastasis of various tumors. At the same time, cancer stem cells have been relatively less characterized in lung cancers. This review summarizes the current understanding of lung cancer stem cells, including their molecular features and signaling pathways that drive their stemness. This review also discusses the potential startegies to inhibit the signaling pathways driving stemness, in an effort to eradicate these cells to combat lung cancer.

Motivations toward smoking cessation, reasons for relapse, and modes of quitting: results from a qualitative study among former and current smokers

BACKGROUND

Smoking cessation plays a crucial role in reducing preventable morbidity and mortality and is a recognized public-health-policy issue in many countries. Two of the most important factors that affect the efficacy of quitting smoking are motivation and the ability to cope with situations causing relapse.

AIM

The objective of the study reported here was to investigate former and current smokers' motivations for smoking cessation, reasons for relapse, and modes of quitting.

METHODS

We arranged four focus groups with 24 participants (twelve current and twelve former smokers) and eleven semi-structured interviews (five current and six former smokers) with a view to understanding and categorizing their opinions on motivations and the course and process of smoking cessation. The data were next analyzed using descriptive qualitative methods.

RESULTS

THREE MAIN THEMES WERE IDENTIFIED: (1) motivations to quit smoking, (2) reasons why smokers sometimes relapse, and (3) modes of quitting smoking. Within the first theme, the following six subthemes surfaced: (1) a smoking ban at home and at work due to other people's wishes and rules, (2) the high cost of cigarettes, (3) the unpleasant smell, (4) health concern, (5) pregnancy and breastfeeding, and (6) a variety of other factors. The second theme encompassed the following subthemes: (1) stress and the need to lessen it by smoking a cigarette, (2) the need to experience the pleasure connected with smoking, and (3) the smoking environment both at home and at work. Participants presented different smoking-cessation modes, but mainly they were unplanned attempts.

CONCLUSION

Two very important motivations for smoking cessation were a smoking ban at home and at work due to other people's wishes and rules, and the high cost of cigarettes. The most common smoking-cessation mode was a spontaneous decision to quit, caused by a particular trigger factor. Relapse causes encompassed, most notably: stress, lack of the pleasure previously obtained from smoking, and the smoking environment.

Correlates of cessation success among Romanian adults

BACKGROUND

Tobacco smoking and its consequences are a serious public health problem in Romania. Evidence-based data on factors associated with successful smoking cessation are crucial to optimize tobacco control. The aim of the study was to determine the sociodemographic and other factors associated with smoking cessation success among adults.

MATERIALS AND METHODS

Data was from a sample of 4,517 individuals derived from the Global Adult Tobacco Survey (GATS). GATS is a cross-sectional, nationally representative household survey implemented in Romania in 2011. Data was analyzed with logistic regression.

RESULTS

Among females, the quit rate was 26.3% compared with 33.1% in males (P < 0.02). We found disparities in cessation success among the analyzed groups of respondents. Being economically active, being aged 40 and above, and having an awareness of smoking health consequences were associated with long-term quitting smoking among men, while initiating smoking at a later age increased the odds of quitting smoking among women. However, cohabitation with nonsmokers was the strongest predictor of successful cessation among both genders.

CONCLUSION

Programs increasing quit rates and encourage cessation among groups less likely to quit, adopting voluntary smoke-free homes, and increasing the awareness of smoking and tobacco pollution risks are needed.

Predisposing, enabling and reinforcing factors associated with smoking relapse among hospital workers

OBJECTIVES

A better identification of the determinants of smoking relapse among hospital workers would be helpful in development of more effective interventions to decrease the frequency of relapses in this group. The aim of this study was to determine the predisposing enabling, and reinforcing factors associated with smoking relapse among workers at a university hospital.

METHODS

This was a case-control study based on a self-administered and structured questionnaire. Cases were all those workers who had relapsed after at least 6 months without smoking, and controls were ex-smokers without relapse for more than 6 months. We obtained the following information: sociodemographic and tobacco consumption characteristics and a list of predisposing, enabling and reinforcing factors.

RESULTS

There were 342 respondents: 114 cases and 228 controls. The variables significantly and independently associated with increased risk of relapse were smoking is my vice (OR=4.02), I'll be able to quit smoking whenever I want (OR=3.43), I have no intention to quit forever (OR=6.02), celebrations (OR=3.93) and weight gain (OR=10.61), while variables associated with lower risk were age (OR=0.88), health-care worker (OR=0.13), years of abstinence (OR=0.91), smoking is a useless habit (OR=0.19) and illness related to tobacco (OR=0.07).

CONCLUSIONS

Health programs against smoking in the hospital setting should include measures aimed at preventing relapse through behavioral support therapies and dietary control with particular attention to changes in factors related to lifestyle and false beliefs (predisposing factors).

German-Language Version of the Compensatory Health Belief Scale

This study constitutes the first psychometric examination of the German-language version of the Compensatory Health Belief (CHB) scale to assess the belief that unhealthy behavior can be compensated for by engaging in healthy behavior. Data from four different Swiss samples of 1,571 adolescents/students (age range 15 – 55 years), collected between 2007 and 2009, were used. Confirmatory factor analysis did not support either the hypothesized 4-factor structure or a second-order factor structure with a latent overall variable for the German-language CHB scale. These results support the inconsistent patterns of CHBs found across European cultures. Thus, the development of behavior-specific scales might be of advantage. Further recommendations for an improvement of the measurement of compensatory health beliefs are discussed.

Critical realism: a practical ontology to explain the complexities of smoking and tobacco control in different resource settings

BACKGROUND

This paper presents critical realism (CR) as an innovative system for research in tobacco prevention and control. CR argues that underlying mechanisms are considered and explored to ensure effective implementation of any program/policy or intervention. Any intervention or program/policy that is transposed from one country to another or one setting to another is complex.

METHODS

The research was undertaken and analyzed through a critical ethnography lens using CR as a philosophical underpinning. The study relied upon the following components: original fieldwork in Nigeria including participant observation of smokers, in-depth interviews and focus groups with smokers, and in-depth interviews with health professionals working in the area of tobacco control in Nigeria.

RESULTS

Findings from this small ethnographic study in Nigeria, suggest that Critical Realism holds promise for addressing underlying mechanism that links complex influences on smoking.

CONCLUSION

This paper argues that understanding the underlying mechanisms associated with smoking in different societies will enable a platform for effective implementation of tobacco control policies that work in various settings.

Predictors of long-term smoking cessation: results from the global adult tobacco survey in Poland (2009-2010)

Background

Expanding the information on determinants of smoking cessation is crucial for developing and implementing more effective tobacco control measures at the national as well as European levels. Data on smoking cessation and its social correlates among adults from middle-income countries of Central and Eastern Europe are still poorly reported in the literature. The aim of the study was to analyze the association of socio-demographic indicators with long term tobacco smoking cessation (quit smoking for at least one year prior to interview) among adults. Moreover, we evaluated motives for giving up smoking from former smokers.

Methods

Data on former as well as current smokers’ socio-demographic and smoking-related characteristics were derived from the Global Adult Tobacco Survey (GATS). GATS is a cross-sectional, nationally representative household survey implemented in Poland between 2009 and 2010. GATS collected data on a representative sample of 7,840 individuals including 1,206 individuals who met the criteria of long-term smoking cessation and 2,233 current smokers. Smoking cessation rate was calculated as the number of former smokers divided by the number of ever smokers. Logistic regression analyses were used to obtain odds ratios (ORs) and 95% confidence interval (CI) of the broad number of variables on successful cessation of smoking.

Results

Among females the quit rate was 30.4% compared to 37.9% in males (p < 0.01). Former smokers declared concerns about the health hazard of smoking (60.8%) and the high price of cigarettes (11.6%) as primary reasons for smoking cessation. Older age, high education attainment, awareness of smoking health consequences was associated with long-term quitting among both genders. Also employed males had over twice the probability of giving up smoking compared with unemployed, and being religious did not contribute to successful smoking cessation.

Conclusion

Results indicated that smoking cessation policies focused on younger age groups are vital for curbing tobacco epidemic in Poland and should become a public health main concern. There is also the need for interventions to raise awareness on smoking health risks and quitting benefits are crucial to increase cessation potential among adult smokers. Nevertheless further effort needs to be done to prevent smoking uptake.

Smoking cessation 1 year poststroke and damage to the insular cortex

BACKGROUND AND PURPOSE

Hospitalization as a result of stroke provides an opportunity to stop smoking that is often not taken up. The present study analyzes sociodemographic, psychological, and lesion-related variables to identify associated factors for smoking cessation during the first year after stroke.

METHODS

We conducted a prospective longitudinal study with a 1-year follow-up of a cohort of 110 patients with acute stroke who were smokers at the time of diagnosis and were admitted consecutively between January 2005 and July 2007.

RESULTS

On hospital release, 69.1% had given up smoking but at 1 year, only 40% had stopped smoking. Of the 110 patients, 27 (24.5%) had an acute stroke lesion in the insular cortex, of which 19 (70.3%) were nonsmokers at 1 year. Strongly associated factors in giving up smoking were the location of the lesion in the insular cortex (OR, 5.42; 95% CI, 1.95-15.01; P=0.001) and having the intention of giving up before the stroke, comparing precontemplating patients (without intention of giving up in the near future) with contemplating and prepared patients (intention of stopping in the near future; OR, 7.29; 95% CI, 1.89-28.07; P=0.004).

CONCLUSIONS

Of patients with stroke who were smokers, only 4 of 10 patients had stopped smoking 1 year after admission. Our results show that the variables best predicting smoking cessation in patients with a stroke diagnosis 1 year after hospital discharge are insular damage and the prestroke intention to stop.

Smoking cessation in persons with serious mental illnesses: the experience of successful quitters

OBJECTIVE

The purpose of the study was to better understand the experiences of persons with serious mental illnesses who have quit smoking.

METHODS

Former smokers with serious mental illnesses who had been abstinent for at least 4 months participated in an individually-administered structured interview about their motivation to quit smoking and the strategies that they used to quit. Participants also were asked about their willingness to assist peers in smoking cessation.

RESULTS

The sample of 78 successful quitters had been abstinent from smoking for an average of 7.4 (±8.6) years after smoking for a mean of 25.3 (±11.4) years; the mean peak quantity of cigarettes smoked was 1.5 (± 1.1) packs per day. The primary reason for quitting smoking was health concerns, endorsed by 57 (73%) of respondents. Additional reasons included the cost of cigarettes (55, 71%); advice from a doctor (42, 54%); advice from others (50, 64%). The main methods that participants cited as enabling them to quit were social support from friends or family (cited by 45, 58%); direction from a doctor (36, 46%); use of nicotine replacement therapy (NRT) (24, 31%); and the advice of friends who had quit (18, 23%). Only a small proportion of the sample had received smoking cessation treatment other than NRT. A large portion of the sample indicated that they would be willing to serve in peer helping roles for smoking cessation.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Persons with serious mental illnesses are able to successfully quit smoking despite extensive histories of heavy smoking. For practitioners, this study also emphasizes the importance of smoking cessation programming that is relevant and easily accessible to people with serious mental illnesses. Importantly, former smokers living with mental illnesses indicated a willingness to be involved in helping others quit, and should be utilized in formal smoking cessation efforts aimed at their peers.

Sex differences in attitudes and experiences concerning smoking and cessation: results from an international survey

OBJECTIVE

Males and females may have different attitudes and experiences concerning smoking and smoking cessation. We examined sex differences in reasons for smoking, motivations for quitting, past quit attempts, and types of cessation support provided by physicians by surveying randomly selected smokers from 16 countries.

METHODS

Current cigarette smokers were surveyed by telephone about their attitudes and experiences regarding smoking and smoking cessation.

RESULTS

Of the 3760 respondents, 1516 (40.3%) were female. Overall, females reported more reasons for smoking, were more likely to be motivated to quit by life changes, and more likely to use medications or counselling for smoking cessation than males. Although 70% of respondents recalled their physician asking about smoking and advising quitting, only 39% of females and 26% of males recalled being offered assistance for cessation. Females recalled more frequent prescription or recommendation of pharmaceutical cessation aids and more assistance in setting a quit date.

CONCLUSION

Males and females have different attitudes and experiences when it comes to smoking and cessation.

PRACTICE IMPLICATIONS

Health care providers can significantly influence smoking-cessation success by offering efficacious treatment to patients. Our data will help physicians to optimally tailor smoking-cessation interventions to patients, according to their sex.

Patterns of family responses to alcohol and tobacco problems

Patterns of family response to drinking and smoking were studied in a sample of 1034 adults in Ontario in 1993. Concerning tobacco smoking, 69% of respondents reported having said something to a relative and 82% to a friend; concerning drinking, 46% had said something to a relative and 65% to a friend. Having said something did not vary much with the respondent's age, educational level and smoking or drinking status, except that current smokers were less likely than others to have said something to a friend or acquaintance, while heavier drinkers were more likely to have said something to a friend or acquaintance, and ex-drinkers were more likely to have said something to a relative. About half of all who had ever smoked reported a family member (57%) or a friend (47%) had said something to them about their smoking, compared with much smaller proportions of ever-drinkers who reported that a family member (14%) or a friend (8%) had ever said anything about their drinking. Both drinking and smoking are recognized by many respondents as imposing burdens on the family. Family members often comment on drinking and smoking, and make suggestions about cutting down or quitting.

Patterns of motivations and ways of quitting smoking among Polish smokers: a questionnaire study

Background

The majority of Polish smokers declare their will to quit smoking and many of them attempt to quit. Although morbidity and mortality from tobacco-related diseases are among the highest in the world, there is a lack of comprehensive cessation support for smokers. We aimed to investigate how Poles, including the medically ill, cope with quitting cigarettes and what their motivations to quit are.

Methods

Convenience sampling was used for the purpose of the study. Individuals attending several health care units were screened for a history of quit attempts. Ex-smokers were defined as smoking previously at least one cigarette/day but who have no longer been smoking for at least one month. Attempts at quitting were defined as abstaining from cigarettes for at least one day. Data on socio-demographics, tobacco use, quitting behaviors and reasons to quit from 618 subjects (385 ex- and 233 current smokers) who fulfilled these criteria were collected with the use of a questionnaire. For the comparison of proportions, a chi-square test was used.

Results

In the entire study population, 77% of smokers attempted to quit smoking on their own and a similar proportion of smokers (76%) used the cold turkey method when quitting. Current smokers were more likely than former smokers to use some form of aid (p = 0.0001), mainly nicotine replacement therapy (68%). The most important reasons for quitting smoking were: general health concern (57%), personal health problems (32%) and social reasons (32%). However, 41% of smokers prompted to quitting by personal health problems related to tobacco smoking did not see the link between the two. A small proportion of ex-smokers (3%) abstaining from cigarettes for longer than a year were not confident about their self-efficacy to sustain abstinence further.

Conclusion

The majority of Polish smokers, including patients with tobacco-related diseases, attempt to quit without smoking cessation assistance, thus there is a need for a broader professional help for them. There is also a lack of general information on hazards related to tobacco and further anti-tobacco campaigns in media are needed. Finally, former smokers should be given more attention and periodic inquiries regarding the smoking habit are worthwhile.

Motivation to quit using cigarettes: a review

This review asks why persons decide to quit using cigarettes. We summarize three literatures from five decades, including over 30 data sets grouped by different methodologies: (a) retrospective reports of ex-smokers (n = 15), (b) cross-sectional surveys of current smokers (n = 14), and (c) prospective studies of smokers in cessation studies (n = 6). Taken together, the data strongly suggest that health concern is the primary motive for quit attempts. These data fit with theoretical reasoning that persons wish to control danger and negative affect. The data also suggest that health professionals should continue emphasizing the negative health consequences of smoking to motivate cessation attempts.

The meaning of smoking as health and social risk in adolescence

This investigation describes what smoking means to adolescents, and attempts to better understand it as a rite of passage. Applying a social ontology to an often-individualized issue, interviews were conducted with 20 adolescent smokers between the ages of 13 and 19. Results show that adolescents possess detailed information about the risks of smoking. Both age and gender differentiated the meanings of smoking which were found to be both positive and negative. Valence inconsistency increased with age. Results are interpreted within a cultural, developmental framework and suggest reconstructing smoking risks as potentially positive. Implications for research and prevention are discussed.

Association between age, gender and reasons for smoking cessation

AIMS

To contribute to improved programs for smoking cessation, the authors wanted to assess the relationships between age, gender and ex-smokers' quitting reasons and examine predictors of the most commonly reported quitting reasons.

METHODS

A questionnaire was mailed to 11,919 subjects in Akershus County, Norway. Among the 7,697 respondents (65%), self-reported reasons for smoking cessation in 1,715 ex-smokers were analysed. Using cross-tables and multivariate logistic regression, associations between age, gender, and reported quitting reasons were examined.

RESULTS

Men were more likely to have stopped smoking to improve physical fitness, or out of consideration for other family members than the children, and less likely to have quit out of consideration for their own children, or in solidarity with a spouse that stopped smoking. In multivariate logistic regression analysis, age was a predictor of all seven most common reasons to quit smoking. Gender, education, and the physical component of health status each predicted three of the seven quitting reasons.

CONCLUSIONS

In the study sample, differences in smoking cessation behavior and reported quitting reasons were found according to both age and gender. Smoking cessation programs should be tailored to the relevant target groups, including stratification according to age and gender.

Perceived risks and benefits of smoking cessation: gender-specific predictors of motivation and treatment outcome

The primary aim of this study was to examine gender differences in perceived risks and benefits of smoking cessation and their relationship to pretreatment motivation and treatment outcome. No validated measures that comprehensively assess perceived risks and benefits associated with smoking cessation were available in the literature; consequently, we developed a self-report instrument [Perceived Risks and Benefits Questionnaire (PRBQ)] for this purpose. A sample of 573 treatment-seeking smokers (48% female) entering smoking cessation trials completed the PRBQ, and its association with treatment outcome was assessed in a subsample of 93 participants. Overall, the PRBQ demonstrated good psychometric properties. Females indicated greater likelihood ratings of perceived risks and benefits than males. For women and men, perceived benefits were positively associated with motivation, and perceived risks were negatively associated with motivation and treatment outcome. Women evidenced stronger associations between perceived risks and pretreatment motivation, and treatment outcome. Knowledge of perceived risks and benefits associated with smoking cessation is critical for public education campaigns and could inform intervention strategies designed to modify sex-specific beliefs associated with lowered behavioral intentions to quit smoking.

Relationships among smoking status, ethnicity, socioeconomic indicators, and lifestyle variables in a biracial sample of women

BACKGROUND

Smoking prevalence rates remain high among women and smoking initiation has increased for young adults. Little is known about the unique patterns of smoking, risk factors, and correlates of quitting in Black versus White women of child-bearing age.

METHOD

This study examined the relationships among smoking, ethnicity, socioeconomic status (SES), and lifestyle variables among 715 women (43.6% Blacks and 56.4% Whites). Stringent inclusion criteria were used for ethnicity, which allows for distinct comparisons but may reduce generalizability of results.

RESULTS

Black current smokers smoked fewer cigarettes per day and reported initiating smoking at a later age than Whites. Current versus never smoking was associated with income, education, and caffeine intake. There was a significant ethnicity by alcohol interaction (at lower levels of alcohol intake Whites were more likely to smoke but at higher levels of alcohol there were no ethnic differences). Former smoking versus current smoking was associated with alcohol intake, education, and pack years of smoking.

CONCLUSIONS

The results of the study suggest several ethnic differences in smoking patterns as well as several correlates of smoking status. These results have implications for the tailoring of interventions and illustrate the association of other health risk factors with smoking status.

Smoking attitudes and practices among low-income African-Americans: qualitative assessment of contributing factors

PURPOSE

Studies have shown that African-American adolescents are less likely to smoke cigarettes than white youth. National data suggest that this pattern changes in late adolescence and early adulthood. Specifically, African-American adults have a relatively high smoking prevalence rate when compared with other racial/ethnic groups. The purpose of this study was to qualitatively examine the sociocultural factors associated with smoking attitudes and practices among low-income African-American young adults.

DESIGN

Cross-sectional qualitative study.

SETTINGS

High schools, 2-year colleges, housing developments, and trade schools in New Orleans, Louisiana, and Memphis, Tennessee.

SUBJECTS

One hundred eighteen low-income African Americans between 18 and 35 years of age (65 men and 53 women). MEASURE/PROCEDURE: Fourteen focus groups were conducted with the target population. Nonmonetary incentives were provided for each participant in the 1-hour sessions. The majority of focus group moderators were African-American females trained in focus group moderation. Participants were recruited through flyers and project liaisons at each field location.

RESULTS

Themes elicited from the focus groups were classified according to the PEN-3 model, and they included: lighting cigarettes for parents as a first experience with cigarettes, perceived stress relief benefits of smoking, use of cigarettes to extend the sensation of marijuana, and protective factors against smoking such as respect for parental rules.

CONCLUSION

The results indicate that there are specific contextual and familial factors that can contribute to smoking initiation, maintenance, and cessation among low-income African-American young adults. Limitations of this study include the exploratory nature of focus groups and the relatively small sample size. Further studies are necessary to quantitatively examine the role of these factors on smoking patterns in this population.

Evaluation of a culturally appropriate smoking cessation intervention for Latinos

BACKGROUND

Many believe that smoking cessation programmes for Latinos should be tailored to the values and beliefs of the culture. However, randomised studies of culturally appropriate smoking cessation interventions with Latinos are rare.

METHODS

Latino smokers (n = 313) were randomised to an intervention condition or a comparison group. The intervention was a three month programme based on social cognitive constructs and delivered in the smoker's home by trained lay health advisors, or promotores. Comparison group participants were referred to the California Smoker's Helpline in Spanish. Predictors of abstinence among all participants also were examined.

RESULTS

About one week post-intervention, validated (carbon monoxide) past week abstinence rates were more than twice as high in the intervention group (20.5%) than in the comparison (8.7%) (p < or = 0.005). The pattern of results held for self reported abstinence, and after recoding dropouts to non-abstinence. The primary predictor of abstinence was number of cigarettes smoked per day at baseline, a common measure of addiction.

CONCLUSIONS

The culturally appropriate intervention facilitated abstinence in Latino smokers, at least in the short term. Strengths and weaknesses of the study are discussed.

An exploration of health beliefs and attitudes of smokers with vascular disease who participate in or decline a smoking cessation program

The descriptive cross-sectional aspect of this study compared a group of smokers with peripheral arterial disease who chose to participate in a smoking intervention with a group of smokers with peripheral arterial disease who declined to participate. The longitudinal aspect of this study used Ajzen and Fishbein's(1) Theory of Reasoned Action, Keeney's(2) Expected Utility Decision Theory, and Prochaska and DiClemente's(3) Transtheoretical Model of Change to describe the influence of this smoking cessation program on the beliefs and attitudes about smoking in group 1. Smokers completed a smoking beliefs questionnaire with vascular disease at baseline and after 13 weeks of smoking cessation intervention. Smokers who did not want to participate in the smoking cessation program also completed this questionnaire for comparison. Statistically significant differences were found to differentiate people who enrolled in the smoking cessation program from those who did not. Subjects in group 2 smoked less per day, were less educated, were less often diagnosed as having peripheral arterial disease, were found to be more in the precontemplation stage of change in smoking cessation, cared more about what their physician and family thought they should do, and perceived themselves to be at less risk for developing more severe circulatory problems if they did not quit smoking. After 13 weeks, participants in both groups 1 and 2 were found to smoke significantly less per day. No support was found for the expectation that the smoking intervention would influence stage of change in smoking behavior or attitudes and beliefs about the risks of smoking to the participants' health after 13 weeks.

Effects of gender in social control of smoking cessation

This study of 93 men and 117 women smokers during an ongoing quit attempt examined the roles of gender and social network influences on quitting. For men, social influences appeared to positively affect their ability to reduce their smoking but were less effective for women. Specifically, increased reports of a spouse or partner's influence, and family and friends' influence, were associated with greater reductions in men's smoking 2 days and 4 months post quit date, respectively. In contrast, for women, greater reports of spouse or partner influence and of family and friends' influence were associated with smaller reductions in smoking. Sex differences in social control strategies and perceived autonomy supportiveness of those strategies are discussed as possible explanations for these results.

Examination of the temporal relationship between smoking and major depressive disorder among low-income women in public primary care clinics

PURPOSE

To determine the prevalence of major depressive disorder (MDD) by smoking status, and the temporal relationship between smoking and MDD, and explore other smoking-related variables that may be associated with MDD.

DESIGN

Cross-sectional study.

SETTING

Public primary care clinics.

SUBJECTS

Researchers studied 338 women (76% African-Americans) who were randomly selected while attending appointments in two public primary care clinics.

MEASURES

Data pertaining to smoking-related variables and MDD diagnosis were obtained using the Diagnostic Interview Schedule for the Diagnostic Statistical Manual of Mental Disorder IV (DSM-IV).

RESULTS

The prevalence of a lifetime history of MDD was significantly higher for current smokers (56.6%) than among former smokers (37.5%) or never-smokers (30.3%; p < .001). Most ever-smokers (81.3%) began smoking and were nicotine-dependent (63.6%) prior to their first episode of MDD. Using logistic regression, after controlling for demographic and smoking-related variables, age of smoking onset was the strongest variable associated with MDD among ever-smokers. Specifically, the odds of having an MDD decreased by 8.2% for each year delay in smoking initiation.

CONCLUSION

These results suggest that smoking initiation precedes MDD and that smoking is associated with a high prevalence of MDD among low-income women attending primary care clinics. Further, the younger women start smoking the more likely they are to have MDD.

Exploring the association between perceived risks of smoking and benefits to quitting: who does not see the link?

This report explored associations between different measures of smokers' perceived risks of smoking and benefits to quitting and the extent to which these associations varied by demographic and other characteristics for 144 smokers. We hypothesized greater perceived risk of smoking would be associated with greater perceived benefits to quitting and would be strongest among smokers who were concerned about health effects of smoking and motivated to quit. Results indicated smokers' perceived themselves at risk for lung cancer regardless if they continued or quit smoking and was strongest for smokers who were older and minimized the importance of reducing lung cancer risk. There was a weak correlation between perceived risk for lung cancer when compared to nonsmokers and perception that quitting smoking would reduce lung cancer risk and was weakest for African Americans, lighters smokers, and smokers with higher intrinsic relative to extrinsic motivation for cessation. In conclusion, these subgroup differences in the relationship between perceptions of risks and benefits could be important to consider to increase the relevance and motivational potency of smoking cessation interventions.

Age and the role of symptomatology in readiness to quit smoking

To develop effective age-appropriate strategies for smoking cessation, it is important to understand factors associated with readiness to quit smoking. This article presents results from an analysis of the role of symptomatology in the decisions to quit smoking among three age groups (18-34, 35-54, and > or = 55 years) from a larger sample of smokers in a managed-care setting. Two measures of readiness to quit smoking were used: stages of change and intention to stop. Using ordinal logistic regression, we found that smokers in the middle and oldest age groups who had experienced at least three of five symptoms in the previous 2 weeks were more likely to be in higher stages of readiness. Regardless of age, smokers who attributed symptoms to smoking were more motivated to try to quit, whereas those who attributed symptoms to aging were less likely to intend to stop smoking. Findings from this study indicate a symptom-based approach to smoking cessation may be a useful strategy, especially in provider-based interventions.

Investigation of Cigarette Smokers Who Quit without Treatment

This study investigates the phenomenon of spontaneous recovery through qualitative methodology. The Development Research Model, as introduced by James Spradley (1979) was employed with a sample of people who quit smoking without the aid of formal treatment. This technique examines the language used by informants to describe the experience of quitting. The results report that many of the informants used multiple techniques. Also of importance is the finding that the majority of the informants had relapsed and used the experience as motivation to continue trying to quite smoking. It was also found that many individuals experienced vivid dreams about smoking while undergoing the cessation process. Several important factors about the decision to quit are discussed as well as the treatment implications.

Smokers' misperceptions of light and ultra-light cigarettes may keep them smoking

INTRODUCTION

This study examined smokers' understanding of the relative tar deliveries of Ultra-light, Light, and Regular cigarettes, reasons for smoking Ultra-light/Light cigarettes, and the likelihood of both quitting smoking and switching to Regular cigarettes if they came to learn that one Ultra-light/Light cigarette gave the same amount of tar as one Regular cigarette.

DESIGN

Ten- to fifteen-minute random-digit-dialed, computer-assisted telephone interviews (CATI) were conducted with both a national probability sample (n = 788) and a state random sample (n = 266) of daily smokers over the age of 18.

RESULTS

Less than 10% of smokers in the national sample and only 14% of smokers in the state sample knew that one Light cigarette could give the same amount of tar as one Regular cigarette. Less than 10% of smokers in the state sample knew that one Ultra-light cigarette could give the same amount of tar as one Regular cigarette. Thirty-two percent of the Light and 26% of the Ultra-light smokers in the national sample, and 27% of Light and 25% of Ultra-light smokers in the state sample, said they would be likely to quit smoking if they learned one Light/Ultra-light equaled one Regular.

CONCLUSION

Many Light and Ultra-light smokers are smoking these cigarettes to reduce the risks of smoking and/or as a step toward quitting. However, these smokers are unaware that one Ultra-light/Light cigarette can give them the same amount of tar and nicotine as one Regular cigarette. Many of the Ultra-light/Light smokers sampled in this study stated that they would be likely to quit if they knew this information. Mistaken beliefs about low-yield brands are reducing intentions to quit smoking.

Issues related to smoking cessation among substance abusers

Initial studies have found that stop-smoking treatments for newly recovering substance abusers have been neither harmful to sobriety nor effective in achieving smoking cessation. The development of more effective stop-smoking treatments for this population could be aided by delineating their particular smoking-related characteristics. This article describes the biopsychosocial characteristics of newly recovering substance abusers that are relevant to smoking cessation, and suggests that there are notable differences between abusers and nonabusers that may contribute to abusers' greater difficulty in quitting smoking. It also recommends changes in existing treatment protocols where applicable and identifies key areas for future research.

Smoking initiation and cessation in African Americans attending an inner-city walk-in clinic

OBJECTIVES

Data collected from a population of African Americans were analyzed to examine patterns of smoking initiation, smoking cessation, and factors related to smoking cessation.

METHODS

Over a 4-month period, all (N = 2,928) patients attending an inner-city medicine clinic were recruited to participate in a smoking intervention trial. Over 99% participated, providing information on their smoking experiences, including smoking status (current, former, or never a smoker), duration of regular smoking, and year of quitting when applicable. Data on African Americans with complete information on these variables (n = 2,428) were analyzed with respect to initiation and duration of smoking.

RESULTS

More than half of African-American smokers in the population studied initiated regular smoking after age 19. Later age of initiation of smoking and female gender were associated with short duration smoking (i.e., quitting before 10 years of regular smoking); these variables, but not age, were identified as significant factors in a Cox Proportional Hazards model with duration of smoking as the outcome variable.

CONCLUSIONS

A sizable opportunity for primary prevention of regular smoking appears to exist among African Americans aged 20 to 30 years as evidenced by patterns of smoking initiation in the population studied. The importance of age at initiation of regular smoking to the duration of smoking is demonstrated in this population over a wide range of duration.

Motivation for smoking cessation among the Norwegian public

A questionnaire survey among a representative sample of Norwegians (N = 5,014) showed that 33% (n = 1,639) smoked. About one-third of the cigarette smokers were motivated to quit, and they most frequently wished to be informed about smoking-cessation methods. Participation in a smoking-cessation group was the variable most significantly associated with a general motivation to quit. The Smoking Effects Questionnaire (SEQ) tested smokers' perception of smoking consequences. Two SEQ dimensions significantly affected general motivation. Women tended to emphasize the effect of smoking on physical appearance, whereas men were more concerned about their health.

Smoking cessation. 2: Components of effective intervention

Smoking cessation treatment is an essential component of comprehensive healthcare, but many healthcare providers lack formal training and are hesitant to provide such intervention. The recently published US Agency for Health Care Policy and Research (AHCPR) Smoking Cessation Clinical Practice Guideline provided empirically based recommendations to address these issues. The most effective components of smoking cessation include the use of nicotine replacement therapy, provider support and encouragement, and training in such skills as problem solving and coping. Methods of using these recommendations are illustrated, and sample scripts are offered to serve as references for providers from various disciplines who conduct smoking cessation interventions.