The psychological determinants of low-rate daily smoking

A Mobile Smoking Cessation Intervention for Mexico (Vive sin Tabaco... ¡Decídete!): Single-Arm Pilot Study

BACKGROUND

Of the 14.3 million Mexicans who smoke, only a minority take advantage of evidence-based approaches to smoking cessation. Mobile health interventions have the potential to increase the reach of effective cessation interventions in Mexico.

OBJECTIVE

This study aimed to assess the feasibility and acceptability of an innovative, personalized, and interactive smoking cessation mobile intervention developed for Mexican smokers.

METHODS

We recruited 40 Mexican smokers to participate in Vive sin Tabaco... ¡Decídete!, a smoking cessation program that uses a tablet-based decision support software to drive a 12-week text messaging smoking cessation program and pharmacotherapy support. Outcome measures included participant text messaging interactivity with the program, participant satisfaction, and 12-week verified abstinence using urinary cotinine testing or exhaled carbon monoxide.

RESULTS

Average age of the participants was 36 years (SD 10.7), and they were primarily male (65%, 26/40) with at least an undergraduate degree (62%, 25/40). Most participants (95%, 38/40) smoked daily and were interested in quitting in the next 7 days. As an indicator of participant interactivity, participants sent an average of 21 text messages during the 12-week intervention (SD 17.62). Of the 843 messages that participants sent to the program, only 96 messages (11.3%, 96/843) used keywords. At 12 weeks, 40% (16/40) of participants were biochemically verified (87%, 35/40, follow-up rate). The majority of participants (85%, 30/35) reported being very satisfied or extremely satisfied with the program.

CONCLUSIONS

The Vive sin Tabaco... ¡Decídete! smoking cessation mobile intervention was accepted by participants, generated high satisfaction and high text messaging interactivity, and resulted in a noteworthy cessation rate at the end of treatment. This intervention is a promising strategy for smoking cessation in Mexico. Additional testing as a formal randomized clinical trial appears warranted.

Neurophysiological Measures of the Perception of Antismoking Public Service Announcements Among Young Population

Tobacco constitutes a global emergency with totally preventable millions of deaths per year and smoking-related illnesses. Public service announcements (PSAs) are the main tool against smoking and by now their efficacy is still assessed through questionnaires and metrics, only months after their circulation. The present study focused on the young population, because at higher risk of developing tobacco addiction, investigating the reaction to the vision of Effective, Ineffective and Awarded antismoking PSAs through: electroencephalography (EEG), autonomic activity variation (Galvanic skin response—GSR- and Heart Rate—HR-) and Eye-Tracking (ET). The employed indices were: the EEG frontal alpha band asymmetry and the frontal theta; the Emotional Index (EI), deriving from the GSR and HR signals matching; the ET Visual Attention (VA) index, based on the ratio between the total time spent fixating an area of interest (AOI) and its area. Smokers expressed higher frontal alpha asymmetry values in comparison to non-smokers. Concerning frontal theta, Awarded PSAs reported the highest values in comparison to both Effective and Ineffective PSAs. EI results highlighted that lowest values were expressed by Heavy Smokers (HS), and Effective PSAs obtained the highest EI values. Finally, concerning the Effective PSAs, regression analysis highlighted a correlation between the number of cigarettes smoked by participants (independent variable) and frontal alpha asymmetry, frontal theta and EI values. ET results suggested that for the Ineffective PSAs the main focus were texts, while for the Effective and Awarded PSAs were the visual elements. Results support the use of methods aimed at assessing the physiological reaction for the evaluation of PSAs images, in particular when considering the smoking habits of target populations.

Sociodemographic and Psychological Characteristics of Very Light Smoking Among Women in Emerging Adulthood, National Survey of Drug Use and Health, 2011

Introduction

Although smoking prevalence and average cigarette consumption have declined, very light smoking (5 or fewer cigarettes per day) has increased. Very light smoking is common among young adult women. This study examines the differences between the sociodemographic and psychosocial factors associated with women in emerging adulthood who are very light smokers and similar women who are at other smoking levels.

Methods

The sample consisted of 9,789 women aged 18 to 25 years who took part in the 2011 National Survey on Drug Use and Health in the United States. Variables were sociodemographic factors, psychological adjustment, substance misuse, smoking attitudes, daily smoking, age at smoking initiation, and nicotine dependence. Analyses used were χ² and multinomial logistic regression.

Results

Almost a fifth of participants and about three-fifths of smokers were very light smokers (no more than 5 cigarettes per day). Very light smokers were relatively more likely than other smokers to be young (aged 18 to 20), to be from a minority group, and to have some college education. They also were less likely to be married. The characteristics of very light smokers (poor psychological adjustment and tendency to misuse other substances) were similar to the characteristics of other smokers. However, very light smokers were more likely than other smokers to recognize high risks in smoking, less likely to report nicotine dependence, and more likely to be nondaily smokers.

Conclusion

Prevention programs targeting women in emerging adulthood need to recognize the prevalence of very light smoking in this population. Although comorbid psychological disorders and substance use present challenges, very light smokers’ perception of higher smoking risks and lower nicotine dependence compared with that of other smokers provide intervention opportunities.

Depression and substance abuse and dependency in relation to current smoking status and frequency of smoking among nondaily and daily smokers

BACKGROUND AND OBJECTIVES

Daily smoking rates are decreasing while intermittent or nondaily smoking rates are increasing. Little is known about the association of depression, alcohol abuse and dependence, and illicit drug abuse and dependence with different patterns of smoking, particularly nondaily smoking. Thus, we examined these relationships among current smokers versus nonsmokers and among those who smoke daily versus less frequently.

METHODS

We conducted a secondary analysis of 37,897 adults who participated in the 2008 National Survey on Drug Use and Health. We developed logistic regression models examining predictors of (i) current smoking and (ii) number of days smoking per month (1-10 days, 11-29 days, and ≥30 days) among current smokers, focusing on past-year major depression, alcohol abuse and dependence, and illicit drug abuse and dependence.

RESULTS

Compared to nonsmokers, current smokers more frequently reported a major depressive episode (p < .001), alcohol dependence (p < .001) and abuse (p < .001), and illicit drug dependence (p < .001) and abuse (p < .001), controlling for sociodemographics. Among current smokers, greater smoking frequency was associated with illicit drug dependence (p = .004), but lower likelihood of alcohol dependence (p = .01), alcohol abuse (p = .01), and illicit drug abuse (p = .01).

CONCLUSIONS

Although depression and substance use were associated with greater likelihood of smoking, most measures were inversely associated with frequency of smoking. Thus, it is important to examine underlying mechanisms contributing to these counterintuitive findings in order to inform intervention approaches.

SCIENTIFIC SIGNIFICANCE

With increased rates of nondaily smoking, developing a greater understanding about the mental health correlates related to this pattern of smoking is critical.

Nicotine replacement therapy distribution to light daily smokers calling a quitline

BACKGROUND

With an increasing prevalence of lighter smokers presenting for cessation assistance, outcome-based recommendations are needed to inform nicotine replacement therapy (NRT) distribution protocols by quitlines.

METHODS

A quasi-experimental design was utilized to compare quit rates based on samples selected from the time period before and after NRT (gum or lozenge) was offered to light daily smokers (1-9 cigarettes) contacting the New York State Smokers' Quitline. Outcome measures included self-reported 7- and 30-day abstinence rates, numbers of daily cigarettes among continuing smokers, and cost per quit analyses.

RESULTS

Among responders to the follow-up survey, quit rates were higher for those given NRT compared with those not offered NRT at both 7 (33.0% vs. 27.2%; Relative Risk [RR] = 2.25 [95% CI: 1.15, 4.40; p < .05]) and 30 days (28.0% vs. 21.9%; RR = 2.63 [95% CI: 1.25, 5.54; p < .05]). Similar results were obtained based on intent-to-treat analyses for both 7 (13.4% vs. 11.3%; RR = 1.92 [95% CI: 1.08, 3.39; p < .05]) and 30 days (11.4% vs. 9.1%; RR = 2.29 [95% CI: 1.20, 4.40; p < .05]). Among continuing smokers, the mean number of cigarettes smoked per day increased from enrollment to follow-up in both groups, but less so in those receiving NRT. The additional cost associated with providing a 2-week free supply of nicotine replacement to smokers was $52 for gum and $74 for lozenge.

CONCLUSIONS

This study demonstrates that light daily smokers (1-9 cigarettes) who contact a telephone quitline are interested in using NRT if offered and are able to achieve higher quit rates compared with those not offered NRT.

Project Impact: a pharmacotherapy pilot trial investigating the abstinence and treatment adherence of Latino light smokers

Light smoking is particularly prevalent among Latino smokers. Nicotine replacement (NRT) and varenicline are effective medications for smoking cessation for moderate-heavy smokers but have not been tested in light smokers, and thus, there are no treatment guidelines for use with light smokers. This pilot trial tested the efficacy of NRT and varenicline in increasing smoking abstinence among Latino light smokers. A 3-group (NRT, varenicline, and varenicline-placebo) randomized design was used, and Latino light smokers (≤10 cigarettes per day) received 12 weeks of treatment, which included a culturally informed behavioral health session and ongoing medication management visits. At follow-up, there were no abstinent participants in the placebo and NRT groups. However, 30% of participants in the varenicline group were abstinent at the 3-, 4-, and 6-month follow-up. This study represents the only investigation that specifically targets Latino light smokers using these treatments and characterizing their treatment adherence.

Differences between Latino daily light and heavier smokers in smoking attitudes, risk perceptions, and smoking cessation outcome

INTRODUCTION

Daily light smoking is increasing and disproportionately represented among Latinos. The current study examines differences in smoking attitudes, psychosocial characteristics, risk perceptions, and cessation rates between Latino daily light (3-9 cigarettes/day) and heavier smokers (≥ 10 cigarettes/day).

METHODS

Participants (N = 131; M(age) = 36.8, 73.3% female, 53.1% light smokers) were enrolled in a study focused on motivating smokers to quit. Cessation was biochemically verified at 2 and 3 months after end of treatment.

RESULTS

Heavier smoking was more prevalent among males (65.7%) and those from Puerto Rico (69.0%). Compared with heavier smokers, light smokers were less nicotine dependent (p < .001), reported fewer pros of smoking (p ≤ .001), less perceived stress (p ≤ .001), had fewer friends who smoked (p ≤ .005), were more likely to live in a household with an indoor smoking ban (p ≤ .001), and self-reported better health (p < .05). Regarding risk perceptions, Latino light smokers reported less perceived vulnerability for the health effects from smoking on their child's health (p < .05). There were no significant differences in smoking cessation rates between daily light and heavier smokers at either 2- or 3-month follow-up. Belief that quitting would improve "their own health," however, significantly predicted smoking cessation at both 2- and 3-month follow-up, but only among heavier smokers.

CONCLUSIONS

Latino light smokers do not seem to be more likely to quit smoking than Latinos who smoke at heavier rates. Differences between Latino light and heavier smokers in demographics, smoking attitudes, and psychosocial factors may need to be considered when developing cessation programs and mass media campaigns. Future research should continue to explore whether Latino light smokers need different or more targeted treatments.

Results of a feasibility and acceptability trial of an online smoking cessation program targeting young adult nondaily smokers

Despite increases in nondaily smoking among young adults, no prior research has aimed to develop and test an intervention targeting this group. Thus, we aimed to develop and test the feasibility, acceptability, and potential effectiveness of an online intervention targeting college student nondaily smokers. We conducted a one-arm feasibility and acceptability trial of a four-week online intervention with weekly contacts among 31 college student nondaily smokers. We conducted assessments at baseline (B), end of treatment (EOT), and six-week followup (FU). We maintained a 100% retention rate over the 10-week period. Google Analytics data indicated positive utilization results, and 71.0% were satisfied with the program. There were increases (P < .001) in the number of people refraining from smoking for the past 30 days and reducing their smoking from B to EOT and to FU, with additional individuals reporting being quit despite recent smoking. Participants also increased in their perceptions of how bothersome secondhand smoke is to others (P < .05); however, no other attitudinal variables were altered. Thus, this intervention demonstrated feasibility, acceptability, and potential effectiveness among college-aged nondaily smokers. Additional research is needed to understand how nondaily smokers define cessation, improve measures for cessation, and examine theoretical constructs related to smoking among this population.

Smoking frequency among current college student smokers: distinguishing characteristics and factors related to readiness to quit smoking

Given the increased prevalence of non-daily smoking and changes in smoking patterns, particularly among young adults, we examined correlates of smoking level, specifically motives for smoking, and readiness to quit smoking among 2682 college undergraduates who completed an online survey. Overall, 64.7% (n = 1736) were non-smokers, 11.6% (n = 312) smoked 1-5 days, 10.5% (n = 281) smoked 6-29 days and 13.2% (n = 353) were daily smokers. Ordinal regression analyses modeling smoking level indicated that correlates of higher smoking level included having more friends who smoke (β = 0.63, 95% CI 0.57-0.69) and more frequent other tobacco use (β = 0.04, 95% CI 0.02-0.05), drinking (β = 0.04, 95% CI 0.02-0.07) and binge drinking (β = 0.09, 95% CI 0.06-0.13). Bivariate analyses indicated that daily smokers (versus the subgroups of non-daily smokers) were less likely to smoke for social reasons but more likely to smoke for self-confidence, boredom, and affect regulation. Controlling for sociodemographics, correlates of readiness to quit among current smokers included fewer friends who smoke (P = 0.002), less frequent binge drinking (P = 0.03), being a social smoker (P < 0.001), smoking less for self-confidence (P = 0.04), smoking more for boredom (P = 0.03) and less frequent smoking (P = 0.001). Specific motives for smoking and potential barriers to cessation particularly may be relevant to different groups of college student smokers.

Are occasional smokers a heterogeneous group? An exploratory study

BACKGROUND

Occasional smokers represent an important segment of all smokers and have been described to be a heterogeneous group in terms of past experience and likelihood of maintaining nondaily smoking behavior.

METHODS

In the prospective Ontario Tobacco Survey, 408 occasional smokers were followed for a year. Characteristics of subgroups of occasional smokers, as suggested by previous literature, were studied for personal and smoking behavior group differences. Agglomerative hierarchical clustering was also used to empirically identify subgroups of occasional smokers using average linkage. Smoking status at 1-year follow-up was examined overall and by the identified subgroups to determine if any were useful predictors of persistent status as nondaily smoking and likelihood of smoking cessation.

RESULTS

Significant differences were seen among the subgroups of occasional smokers suggested in previous studies including the number of quit attempts, setting a firm quit date, and whether or not participants cared others knew they smoked in descriptive analyses. Exploratory cluster analysis suggested 4 clusters of occasional smokers based on differences in age, perceived addiction, and history of daily smoking. Subgroups based on participants' history of smoking, self-reported addiction level, and empirically identified cluster subgroups resulted in significant differences of smoking status at 1-year follow-up.

CONCLUSIONS

This study suggests that occasional smokers may be a heterogeneous group with different subgroups characterized by age, accumulated smoking experience and smoking pattern, as well as factors associated with the likelihood of quitting altogether, over time, and perceived addiction.

Smoking prevalence, cigarette consumption and advice received from physicians: Change between 1996 and 2006 in Geneva, Switzerland

OBJECTIVE

To assess change between 1996 and 2006 in smoking prevalence, cigarette consumption, quit attempts, motivation to quit and advice received from physicians in Geneva, Switzerland.

METHODS

Postal surveys in cross-sectional, representative samples of the general population of Geneva in 1996 and 2006.

RESULTS

There were 742 participants in 1996 (response rate 75%) and 1487 in 2006 (response rate 76%). Smoking prevalence remained stable between 1996 (28.0%, 95% confidence interval: 24.7 to 31.3%) and 2006 (26.5%, 24.3 to 28.7%, p=0.46). Among smokers, cigarette consumption fell from 15 to 13 cig./day between 1996 and 2006 (p=0.003). However, tobacco dependence, as measured by the Heaviness of Smoking Index, remained stable (mean=1.9 vs. 1.7, p=0.18). The proportion of smokers who made a 24-hour quit attempt in the previous year remained stable (29.2% in 1996, 32.1% in 2006, p=0.52), but more smokers reported that they intended to quit in the next 6 months in 2006 (39.6%) than in 1996 (29.1%, p=0.045). The association between smoking prevalence and income was stronger in 2006 (chi(2)=53.7, p<0.001) than in 1996 (chi(2)=10.9, p=0.012). In 2006 (no change since 1996), few smokers reported that, during their last medical visit, their physician told them to quit smoking (27.3%) or offered them help to quit (13.3%).

CONCLUSIONS

Over these 10 years, smoking prevalence, nicotine dependence levels and the frequency of quit attempts remained stable, but smokers' motivation to quit increased. We observed a growing social gap in smoking prevalence and cigarette consumption. Smoking cessation advice was seldom received during medical visits.

Characteristics and consistency of light smoking: long-term follow-up among Finnish adults

INTRODUCTION

The main body of smoking behavior research has targeted primarily moderate and heavy smoking. This study aimed to define characteristics of daily light smoking and to examine the consistency of this smoking pattern.

METHODS

We examined light smoking among the Finnish adult population using longitudinal data from the Older Finnish Twin Cohort, collected in 1975, 1981, and 1990. We defined light smoking as fewer than 5 cigarettes/day and heavy smoking as 20 or more cigarettes per day. We examined the characteristics of light smokers in comparison to heavy smokers, studied which baseline features predicted change in the light smoking pattern, and described how this pattern changed over time.

RESULTS

Among 9,940 current smokers in 1975, we identified 772 (7.8%) light smokers and 2,668 (26.9%) heavy smokers. Cross-sectionally, light smoking was characterized by female sex; younger age; higher education; lower consumption of alcohol, coffee, and other tobacco products; being single and physically active; and older age at smoking onset. Light smokers reported strong inhalation of cigarette smoke less often than did other smokers. Longitudinally, higher education, binge drinking, and moving in with a partner predicted changes in light smoking. The majority of the baseline light smokers were former, moderate, or heavy smokers at follow-ups, whereas only about 6% reported consistent light smoking throughout the 15-year study period.

DISCUSSION

In long-term follow-up, consistent light smokers represent a relatively small fraction of smokers. This dynamic pattern of light smoking complicates inferences from studies of health consequences, suggesting that light smoking should not be evaluated based on a single assessment.

Intermittent smokers who used to smoke daily: a preliminary study on smoking situations

INTRODUCTION

As many as half of intermittent (i.e., nondaily) smokers once smoked daily. Little is known about their transition from daily to intermittent smoking, a process that eventually leads them to forego smoking on some days.

METHOD

The present study attempted to gain insight by analyzing situations in which these individuals were likely to smoke. It used data from a California population tobacco survey with a supplemental questionnaire on smoking situations of young adults (aged 18-29 years, n = 1,581). The analysis in the present study divided smokers into three groups: daily smokers, intermittent smokers who never smoked daily (never-daily intermittent), and intermittent smokers who formerly smoked daily (former-daily intermittent).

RESULTS

Former-daily intermittent smokers were more similar to never-daily intermittent smokers than to daily smokers in seven types of smoking situation, regardless of whether the situations were more social and episodic, such as "at parties," or more routine, such as while "driving." This held true even though these former-daily intermittent smokers were daily smokers only about 22 months on average before the survey. It appears that former-daily intermittent smokers reduce their probability of smoking across all situations.

DISCUSSION

We propose a simple model to explain how a reduction in smoking probability across all situations might lead former-daily intermittent smokers to first forego smoking on days with no social events. The fact that smokers frequently go from daily to nondaily smoking has both theoretical and practical implications for nicotine research and for public health campaigns to reduce tobacco-related diseases.

Most Latino smokers in California are low-frequency smokers

AIMS

We examine the phenomenon of low-frequency smoking (non-daily smoking or smoking </= 5 cigarettes daily) among California Latinos and address its implications for addiction theory and population tobacco control.

DESIGN, SETTING AND PARTICIPANTS

Data gathered in 2001 and 2003 through the California Health Interview Survey (CHIS), the largest general health survey in California. The present study focused on Latino current smokers (n = 1254 for CHIS 2001; n = 946 for CHIS 2003).

MEASUREMENT

Latino smokers reporting either non-daily smoking or smoking </=5 cigarettes daily were identified and grouped into one category: low-frequency smokers.

FINDINGS

Weighted by population parameters, more than 70% of Latino smokers in California were found to be low-frequency smokers [70.7% (CI = 67.2%, 73.9%) in 2001 and 70.8% (CI = 67.1%-74.2%) in 2003]. This high proportion cut across all demographic dimensions in both surveys, suggesting pervasiveness and reliability of this phenomenon. Proportions for non-daily smokers and low-rate daily smokers were 48.6% and 22.1% in 2001 and 54.9% and 15.9% in 2003. In both surveys, more than 80% of non-daily smokers consumed </= 5 cigarettes on their smoking days.

CONCLUSIONS

The fact that most Latino smokers are low-frequency smokers calls for a new theoretical framework--beyond withdrawal-based theories--to account for the prevalence of this behavior on the population level. It also calls into question the harm-reduction approach as a tobacco control strategy for California Latino populations. Strategies emphasizing that every cigarette can hurt, and encouraging complete cessation, seem more fitting for this group of smokers.

Baseline characteristics and recruitment strategies in a randomized clinical trial of African-American light smokers

PURPOSE

This study describes the design, recruitment, and baseline data of the first smoking-cessation clinical trial for African-American light smokers, Kick It at Swope II (KIS-II).

DESIGN

KIS-II was a randomized trial testing the efficacy of nicotine gum (vs. placebo gum) in combination with counseling (motivational interviewing or health education).

SETTING

This study was conducted at an urban community-based clinic serving predominantly lower-income African-Americans.

SUBJECTS

African-Americans who smoked 1 to 10 cigarettes per day were eligible. Of 1933 individuals screened, 1012 (52%) were eligible and 755 (75%) were enrolled in the study.

MEASURES

Baseline assessment included smoking history and psychometric measures.

ANALYSIS

The majority of participants were women (67%) with a mean age of 45.1 years (SD = 10.7). Participants smoked on average 7.6 cigarettes (SD = 3.21) per day, had a mean exhaled carbon monoxide level of 13.9 ppm (SD = 8.9) and a mean serum cotinine level of 244.2 ng/mL (SD = 154.4), and reported high levels of motivation and confidence to quit smoking.

CONCLUSION

African-American light smokers were motivated to stop smoking and to enroll in a smoking-cessation program. Characteristics of our sample suggest African-American light smokers are an appropriate group for inclusion in smoking-cessation interventions.

Sex differences in the influence of COMT Val158Met on alcoholism and smoking in plains American Indians

BACKGROUND

Alcoholism and heavy smoking are highly comorbid and are cotransmitted in the general U.S. population; however little is known about comorbidity in American Indians. The catechol-O-methyltransferase (COMT) functional polymorphism, Val158Met, has been associated with alcoholism in Caucasians. The aims of our study were firstly to investigate patterns of alcohol and tobacco consumption and comorbidity between alcoholism and smoking in Plains American Indians and secondly to determine the influence, including sexual dimorphic effects, of COMT Val158Met and COMT haplotypes, on these behaviors.

METHODS

Diagnostic and Statistical Manual-III-R lifetime diagnoses were assigned to 342 community-ascertained Plains American Indians (201 women, 141 men). Lifetime drinking and smoking histories were obtained. Five COMT loci, including Val158Met, were genotyped. Haplotype-based analyses identified 1 block with 3 common haplotypes; 2 included Val158, and 1 had the Met158 allele.

RESULTS

The alcoholics drank heavily (12+/-8 drinks/drinking day) but episodically (max 10+/-8 d/mo). Although 62% of male alcoholics and 40% of female alcoholics were smokers (> or =10 cigarettes/d), only 12% of alcoholic men and 8% of alcoholic women smoked heavily (>20/d). In women, the COMT Val158 allele frequency was maximal in alcoholic smokers (0.85), decreasing to 0.74 in nonalcoholic smokers, 0.67 in alcoholic nonsmokers, and 0.64 in nonalcoholic nonsmokers (chi2 = 11.1, 3 df, p = 0.011). Women showed a main effect of Val158 on smoking (p=0.003). Both male and female alcoholics were more likely to have at least 1 Val158 allele compared with nonalcoholics (0.95 vs 0.88, p < 0.05). Approximately 30% of all participants were long-term, nonaddicted light, social smokers (3.6+/-1.7 cigarettes/d); they had the same Val158Met frequencies as nonsmokers. Haplotype analyses supported the Val158Met findings; however, only 1 of the 2 Val158 haplotypes was implicated.

CONCLUSIONS

Plains Indians have different smoking and drinking patterns and considerably less comorbidity between alcoholism and heavy smoking compared with the general U.S. population. Our COMT Val158Met results suggest that there may be both sex differences in the genetic origins of alcoholism and smoking in this population and overlap in genetic vulnerability to both addictions in women.