Reasons for quitting smoking among low-income African American smokers

Impact of COVID-19 predicts perceived risk more strongly than known demographic risk factors

OBJECTIVE

To identify the factors associated with perceived COVID-19 risk among people living in the US.

METHODS

A cross-sectional representative sample of 485 US residents was collected in mid-April 2020. Participants were asked about (a) perceptions of COVID-19 risk, (b) demographic factors known to be associated with increased COVID-19 risk, and (c) the impact of COVID-19 on different life domains. We used a three-step hierarchical linear regression model to assess the differential contribution of the factors listed above on perceived COVID-19 risk.

RESULTS

The final model accounted for 16% of variability in perceived risk, F(18,458) = 4.8, p < .001. Participants who were White reported twice as much perceived risk as participants of color (B = -2.1, 95% CI[-3.4,-0.8]. Higher perceived risk was observed among those who reported a negative impact of the pandemic on their sleep (B = 1.5, 95% CI[0.8,2.1]) or work (B = 0.7, 95%CI[0.1,1.3]). The number of cases per capita in their state of residence, age, or proximity to someone with a COVID-19 diagnosis were not found to meaningfully predict perceived risk.

CONCLUSIONS

Perceived risk was not found to be associated with known demographic risk factors, except that the effect of race/ethnicity was in the opposite direction of existing evidence. Perception of COVID-19 risk was associated with the perceived personal impact of the pandemic.

Motives for Smoking Cessation are Associated with Stage of Readiness to Quit Smoking and Sociodemographics among German Industrial Employees

Purpose.

To test the relationships among particular motives for smoking cessation, stage of readiness to quit (preparation or contemplation), and sociodemographic characteristics.

Design.

A cross-sectional study to examine attitudes toward and use of health promotion at the worksite, using a self-administered questionnaire.

Setting.

Two German metal companies.

Subjects.

Of 1641 responding employees (response rate 65% in company A and 44% in company B), 360 smokers who intended to quit immediately (n = 105) or in the near future (n = 255) were analyzed.

Measures.

The questionnaire comprised of sociodemographic characteristics, smoking behavior, smoking history, readiness to quit smoking, motives to quit, such as coworkers' complaints and health-related or financial concerns. Chi-squared tests and multiple logistic regression analyses were performed.

Results.

Health-related reasons (94%) predominated financial (27%) or image-related (14%) reasons for smoking cessation. Participants in the cessation preparation group were more likely to report an awareness of being addicted (79.6% vs. 58.2%; p < .001) and the negative public image (22.5% vs. 11.6%; p < .01) as reasons for quitting compared with those in the contemplation group. In multivariable regression models, the motives for smoking cessation, including reduced performance, family's and coworkers' complaints, pregnancy/children, and negative public image, but not health-related and financial concerns, differed significantly by gender, age, marital status, education, and occupational status.

Conclusions.

Motives for smoking cessation vary according to the individual's level of readiness to quit and sociodemographic background.

Racially classified social group differences in cigarette smoking, nicotine dependence, and readiness to quit

The purpose was to determine racially classified social group differences in smoking, nicotine dependence, and readiness to quit between African American and Caucasian smokers. The cross-sectional study included 53 African American and 839 Caucasian smokers participating in a larger population-based cessation intervention study. Data were analyzed from the interview conducted before the intervention; half of the participants were in the treatment group, recruited from those who had joined a cessation contest, whereas control group participants were recruited using random-digit dialing and were not in the contest. African Americans began smoking later, smoked fewer cigarettes daily, reported lower nicotine dependence, and had greater readiness to quit smoking than Caucasians. Of those who had ever used an evidence-based method, African American smokers were more likely to only use evidence-based quit methods, whereas Caucasian smokers were more likely to mix evidence-based with "cold turkey." Controlling for demographics and treatment group, racially classified social group was a predictor of readiness to quit smoking. Later, age of initiation, positive partner support, and using evidence-based quit methods also predicted greater readiness to quit.

Associations between coping, affect, and social support among low-income African American smokers

OBJECTIVE

Previous research has documented disparities in smoking cessation between African Americans and Caucasians. Many low-income African American smokers face a range of circumstances that may inhibit effective coping during quit attempts, yet previous research has not considered factors that influence coping in this population. This study examined (a) affect (positive and negative) and (b) perceived social support in association with coping strategies.

METHODS

The baseline assessment of African American smokers (N = 168) enrolled in a randomized controlled trial included the Positive and Negative Affect Schedule, the Multidimensional Scale of Perceived Social Support, and the Brief COPE. A factor analysis of the Brief COPE resulted in two factors, adaptive and maladaptive strategies.

RESULTS

Participants were mostly single (64%), women (61%), with ≥12 years of education (68%), and low-income. They were middle aged (M = 46.1, SD = 8.7), smoked 21.8 (SD = 13.3) cigarettes/day for 24.3 (SD = 11) years, and were moderately nicotine dependent. Results demonstrated that adaptive coping was positively correlated with positive affect and social support. Maladaptive coping was positively correlated with negative affect, and inversely related to positive affect and social support. Multivariate analyses revealed that positive affect and social support were independently associated with adaptive coping strategies. In contrast, maladaptive coping was independently associated with negative affect, but not social support.

CONCLUSIONS

Interventions that harness positive resources, such as social support and positive mood, may facilitate adaptive coping. Also, addressing negative affect among low-income African American smokers may be important to reduce maladaptive coping strategies.

A smoking ban in public places increases the efficacy of bupropion and counseling on cessation outcomes at 1 year

INTRODUCTION

Legal restrictions have contributed to the decline in smoking prevalence in several European countries. We investigated the impact of the Italian 2005 indoor smoking ban on the efficacy of counseling alone or in combination with bupropion for smoking cessation.

METHODS

Before and after the introduction of the ban (2001-2006), 550 smokers were enrolled in the smoking cessation program in Rome and were asked to choose between a 6-week group counseling therapy (GCT) given alone or in combination with 7 weeks of daily bupropion. Follow-up was completed 12, 26, and 52 weeks after the quit day. Due to the observational nature of the study, we used propensity scores to match 138 and 290 subjects (pre-/postban) in the bupropion- and GCT-only groups, respectively.

RESULTS

Covariate balance in the two matched samples was adequate for all variables except "coffee consumption" in the GCT-only group. The regression adjusted odds ratios indicated that the introduction of the ban resulted in 52% reduced odds of continued smoking at 12 months among the GCT + bupropion group and 41% reduced odds in the GCT-only group. We observed that the ban was associated with both increased 12-month abstinence rates and motivation to quit. In a mediation analysis, we determined that the total effect of the smoking ban on the abstinence rate was reduced after controlling for motivation, which confirmed that motivation was a partial mediator.

DISCUSSION

The introduction of an indoor smoking ban improved the efficacy of smoking cessation treatments by possibly providing a setting that increased the level of motivation to stop smoking.

Implicit associations between smoking and social consequences among smokers in cessation treatment

Explicit expectations of the negative and positive social consequences of smoking are likely to have substantial influence on decisions regarding smoking. However, among smokers trying to quit, success in smoking cessation may be related not only to the content of expectancies about smoking's social effects but also to the ease with which these cognitive contents come to mind when confronted with smoking stimuli. To examine this possibility, we used the implicit association test (IAT) [Greenwald, A. G., McGhee, D. E., & Schwartz, J. L. K. (1998). Measuring individual differences in implicit cognition: The implicit association test. Journal of Personality and Social Psychology, 74, 1464-1480] to assess implicit cognitive associations between smoking and negative vs. positive social consequences among 67 heavy social drinkers seeking smoking cessation treatment in a randomized clinical trial. Results showed that the relative strength of implicit, negative, social associations with smoking at baseline predicted higher odds of smoking abstinence during treatment over and above the effects of relevant explicit measures. The only variable that significantly correlated with IAT scores was the density of smokers in participants' social environment; those with more smoking in their social environment showed weaker negative social associations with smoking. Results suggest implicit cognition regarding the social consequences of smoking may be a relevant predictor of smoking cessation outcome.

Characteristics of patients with COPD in three motivational stages related to smoking cessation

OBJECTIVE

To characterize patients with chronic obstructive pulmonary disease (COPD) in different motivational stages related to smoking cessation.

METHODS

633 smoking COPD patients from 67 general practices participated in a cross-sectional study. The patients were compared with respect to health indicators, demographics, self-efficacy, nicotine dependence, attitudes, and action plans.

RESULTS

In line with previous Dutch results, smokers in precontemplation associated significantly fewer advantages with smoking cessation than smokers contemplating quitting and preparing to quit. Preparers had significantly higher self-efficacy expectations about quitting than the other smokers. Patients preparing to quit suffered from more COPD complaints than precontemplators. Smokers contemplating quitting and preparing to quit developed more plans to turn intentions to quit into action.

CONCLUSION

More than 50% of the smokers with COPD are amenable to smoking cessation support. Preparers and contemplators did not differ as much as previous studies found. It would be advantageous to tailor COPD counseling to two distinct groups (unmotivated smokers and smokers motivated to quit), to discuss the advantages of quitting with unmotivated smokers, and to increase self-efficacy, and action planning for smokers motivated to quit.

PRACTICE IMPLICATIONS

COPD patients are amenable to counseling to quit smoking. Addressing COPD complaints may contribute to greater motivation.

Ethnic similarities and differences in reasons for smoking

We examined reasons for smoking among Black and White smokers. We hypothesized that Blacks would be more likely than Whites to cite tension reduction and less likely to cite weight control as a reason for smoking. Black (n = 100) and White (n = 100) female smokers completed the Reasons for Smoking Scale and the Smoking Situations Questionnaire. Regardless of treatment status, Blacks and Whites differed in their reasons for smoking [F(6,191) = 2.24; p < .05]. Blacks, as compared to Whites, less strongly endorsed weight concern as a reason for smoking [F(1,198) = 6.10; p < .05]. Results failed to reveal differences in tension reduction, stimulation, handling, relaxation, addiction, and habit as a function of ethnicity. Results suggest that Blacks and Whites exhibit more similarity than difference in their reasons for smoking.

Social Support and Patient Adherence to Medical Treatment: A Meta-Analysis

In a review of the literature from 1948 to 2001, 122 studies were found that correlated structural or functional social support with patient adherence to medical regimens. Meta-analyses establish significant average r-effect sizes between adherence and practical, emotional, and unidimensional social support; family cohesiveness and conflict; marital status; and living arrangement of adults. Substantive and methodological variables moderate these effects. Practical support bears the highest correlation with adherence. Adherence is 1.74 times higher in patients from cohesive families and 1.53 times lower in patients from families in conflict. Marital status and living with another person (for adults) increase adherence modestly. A research agenda is recommended to further examine mediators of the relationship between social support and health.

Reported cessation advice given to African Americans by health care providers in a community health clinic

Physician smoking cessation advice has been shown to be effective in encouraging patients to attempt cessation. Few studies have examined factors associated with patient-reported physician advice in an inner city community health clinic. Smokers identified via chart review and provider referral met with a study "smoking specialist." Eligible participants self-identified as African American, smoked at least 1 cigarette per day in the prior 7 days, were 18 or older, had access to a telephone, and agreed to consider blood testing for genetic susceptibility to lung cancer. Of the 869 smokers identified, 487 were eligible and completed a brief in-person and a more extensive follow-up telephone survey within one week after their visit. Patient reports of smoking cessation advice by providers were regressed on patient demographic, smoking, health, and social support variables. Seventy percent of participants reported that they had been advised to quit smoking. Smokers who were older, did not smoke menthol cigarettes, were in poorer health, and who had a regular health care provider were most likely to report having received advice. Patients in this community health setting reported high rates of provider advice to quit smoking. Yet, even in this optimal condition, young healthy smokers did not report receiving advice, even when they were ready to quit smoking. Providers may need additional training and prompting to counsel young healthy smokers about the importance of cessation.

Have we lost our way? The need for dynamic formulations of smoking relapse proneness

Current smoking cessation treatments seem to differ from one another in the proportion of ex-smokers who survive the first few days of the quit attempt. After this initial effect, parallel relapse processes appear to unfold in all treatment groups; no available treatments seem to alter the nature of this late relapse process. True relapse prevention will require that we obtain a better understanding of the forces contributing to relapse across the span of the cessation attempt. A working model of dynamic relapse processes may be necessary before treatments can be improved. In this paper, we suggest that the conceptual model of relapse proneness (RP) described originally by the National Working Conference on Smoking Relapse can serve as an ecumenical organizational framework that may be used to integrate and conceptualize relapse data in ways that could generate new strategies for relapse research and inform treatment design. As an illustration, we sketch a preliminary model of RP which postulates that physical withdrawal, stressors/temptations, and cessation fatigue each make independent, time-shifted contributions to relapse risk. A new round of descriptive research focused on relapse proneness processes may be a prerequisite for improving existing smoking cessation interventions.