Nicotine dependence treatment: perceived health status improvement with 1-year continuous smoking abstinence

BACKGROUND

This study evaluated change in health status as a function of change in smoking status among patients treated clinically for nicotine dependence by comparing overall perceived health status of patients who abstained from cigarettes for 1 year versus those who smoked continuously for 1 year.

METHODS

Patients from the Mayo Clinic Nicotine Dependence Center completed a quality-of-life questionnaire (SF-36) following their consultation for nicotine dependence (baseline). At 1 year post-intervention, patients were mailed a follow-up survey that included the SF-36 and items assessing interval smoking history. Study patients included those who self-reported continuous smoking (n=60) and those reporting continuous smoking abstinence for the entire follow-up year (n=146). Data from SF-36 scales at 1 year were analysed using analysis of covariance with baseline scale scores serving as covariates along with baseline characteristics that differed significantly between groups.

RESULTS

Compared with those who continued to smoke, patients who were continuously abstinent from smoking for the entire year had more improvement in perceived health status for the SF-36 mental composite scale (P=0.009) and for the SF-36 subscales for role limitations (P<0.001 and P=0.017 for emotional and physical role limitations, respectively), social functioning (P=0.010) and general health (P=0.013).

CONCLUSIONS

Smokers treated for nicotine dependence who stop smoking for a year report more improvement in-quality-of-life compared with those who continue to smoke.

Exploring the association of John Henry active coping and education on smoking behavior and nicotine dependence among Blacks in the USA

Although smoking is used as a coping tool in response to stress and Blacks have been found to report smoking more in response to stress than Whites, little research exists that has examined ethno-culturally specific constructs of stress and coping as they relate to smoking behavior and nicotine dependence among Blacks in the USA. This study explored the association between the ethno-culturally interactively defined construct of John Henryism, as well as the individual contributions of John Henry active coping and education on smoking behavior and nicotine dependence in a relatively urban-Midwestern Black population. Self-identified Black patients (n = 146) who had previously received a clinical intervention for nicotine dependence were followed to assess smoking status and John Henry active coping. Results revealed that patients with low levels of education who had low levels of John Henry active coping reported higher nicotine dependence scores than any other education by John Henry active coping group. Furthermore, low levels of John Henry active coping were associated with the use of menthol cigarettes and lower-educational level was associated with smoking greater than 20 cigarettes per day. Further community-based studies examining this construct among Black smokers in various socio-cultural contexts are needed to clarify the association between John Henry active coping and socioeconomic status on smoking behavior and nicotine dependence among Blacks.

Predictors of 6-month tobacco abstinence among 1224 cigarette smokers treated for nicotine dependence

This study examined baseline characteristics associated with abstinence from tobacco 6 months after treatment for nicotine dependence. A total of 1224 cigarette smokers (619 females, 605 males) receiving clinical services for treatment of nicotine dependence between January 1, 1995 and June 30, 1997 were studied. The intervention involves a 45-min consultation with a nicotine dependence counselor. A treatment plan individualized to the patient's needs is then developed. The main outcome measure was the self-reported 7-day point prevalence abstinence from tobacco obtained by telephone interview 6-months after the consultation. A bootstrap resampling methodology for predictor variable selection was used to identify a set of multivariate predictors of 6-month tobacco abstinence. Five variables were multivariately associated with tobacco abstinence: male gender, no current psychiatric diagnosis, higher stage of change, longest duration of previous abstinence from tobacco of <1 or > or =30 days, and Fagerström Test for Nicotine Dependence (FTND) score of < or =5. Assessment of these variables may be useful clinically by assisting health care providers in tailoring nicotine dependence interventions to enhance outcomes.

Residential (inpatient) treatment compared with outpatient treatment for nicotine dependence

OBJECTIVE

To compare smoking abstinence outcomes between smokers treated in a residential (inpatient) program and those treated in an outpatient program to determine if residential treatment was superior to outpatient treatment in smokers with moderate to severe nicotine dependence.

PATIENTS AND METHODS

Patients treated in the residential nicotine dependence program at the Mayo Clinic, Rochester, Minn., between May 1, 1992, and January 31, 1996, were selected for this study. Each patient in the residential treatment group (n=146) was matched to 2 patients who received an outpatient nicotine dependence consultation by a trained counselor (n=292). Each patient was matched on age, sex, year seen, number of cigarettes smoked per day, longest previous abstinence, education, and marital status. Abstinence at 6 and 12 months was determined by self-report. For the purposes of analysis, each patient with missing outcome data was considered to be smoking.

RESULTS

The 6-month abstinence rates for the residential group compared with the outpatient group were 45% and 26%, respectively (P<.001), and the 12-month abstinence rates were 45% and 23%, respectively (P<.001). After adjusting for matching variables that were not exactly matched (age, baseline number of cigarettes smoked per day, and longest previous abstinence) and the baseline variables, including education, age when started smoking, and degree of nicotine dependence, there was a significant effect of residential treatment on 6- and 12-month abstinence rates (P<.001). Odds ratio of 6-month abstinence in the residential group was 2.74 (95% confidence interval, 1.60-4.71; P<.001) and at 12 months was 3.03 (95% confidence interval, 1.74-5.27; P<.001).

CONCLUSION

Residential treatment for tobacco dependence is superior to outpatient treatment in some smokers who are moderately to severely nicotine dependent.

Counseling patients to quit smoking. What to say, when to say it, and how to use your time to advantage

Helping patients stop smoking is one of the most important--and frustrating--services primary care physicians can provide. Many physicians are reluctant to spend time talking about tobacco use with patients who show little or no interest in changing their habits. Fortunately, specific technique have been identified that can make the task easier. This article from the distinguished Nicotine Dependence Center of the Mayo Clinic looks at the "best practices" for dealing with nicotine dependence.

Attitudes toward nicotine dependence among chemical dependence unit staff--before and after a smoking cessation trial

As a part of a prospective study to assess the effect of nicotine dependence treatment among smokers undergoing inpatient treatment for other addictions, we surveyed the treatment staff about their attitudes toward smoking. The study was carried out in the Alcoholism and Drug Dependence Unit (ADDU), an inpatient addictions' treatment unit at Mayo Clinic. The subjects for this report were the ADDU staff. The attitude survey used was modified from that of Bobo and Gilchrist, and the survey was conducted for all staff before and after the prospective intervention study. Compared with the pre-study survey, the post-study survey indicated more staff thought nicotine dependence treatment should be provided to all smokers (p = 0.025). The percentage who thought that nicotine dependence treatment should be encouraged at the time of admission to the unit also increased (p = 0.005). Overall, staff attitudes toward nicotine dependence treatment changed toward more acceptance. While the intervention trial likely had an effect, other factors could also have played a role in this apparent change in staff attitude.

Nicotine dependence treatment during inpatient treatment for other addictions: a prospective intervention trial

This study assessed the effect of treating nicotine dependence in smokers undergoing inpatient treatment for other addictions. It was a prospective, nonrandomized, controlled trial with a 1-year outcome. The subjects were smoking patients (50 controls, 51 in intervention group) in an inpatient addictions treatment unit in a medical center. The enrollment of subjects was sequential: controls were enrolled first; after a 6-week washout period, intervention subjects were enrolled. Controls received usual care, and the intervention group received nicotine dependence treatment consisting of a consultation, 10 intervention sessions, and a structured relapse prevention program. Smoking cessation rate and abstinence from alcohol or other drug use were the main outcome measures. The confirmed smoking cessation rate at 1 year was 11.8% in the intervention group and 0.0% in the control group (p = 0.027). Nicotine dependence intervention did not seen to interfere with abstinence from alcohol or other drugs (1-year relapse rate was 31.4% in the intervention group and 34.0% in controls). In this study, nicotine dependence treatment provided as part of addictive disorders treatment enhanced smoking cessation and did not have a substantial adverse effect on abstinence from the nonnicotine drug of dependence.

Inpatient treatment of severe nicotine dependence

The most severely nicotine-dependent patients who have tried traditional treatment programs without success may require maximal intervention to achieve abstinence. In the Clinical Research Center at the Mayo Clinic, we assessed the feasibility of an inpatient treatment program for 24 such subjects, who were hospitalized (in groups of 6) for 2 consecutive weeks. A combination of behavioral, chemical-dependence, and transdermal nicotine-replacement therapy was provided in a smoke-free, protected milieu. Components of the program included group therapy, management of stress, exercise, daily lectures, and supervised activities. The mean age of the 18 women and 6 men was 51.3 years (range, 29 to 69 years). The mean duration of smoking was 33.7 years, and the number of cigarettes smoked per day at the time of admission averaged 33.2. The most frequent tobacco-related medical illnesses were chronic obstructive pulmonary disease, arteriosclerosis obliterans, and coronary artery disease. All subjects but two--each smoked part of a cigarette--remained abstinent from the use of cigarettes while in the Clinical Research Center, and all completed the 2-week inpatient program. The subjects underwent follow-up for 10 weeks after dismissal and were contacted periodically thereafter. At 1 year, 7 of the 24 subjects (29%) had maintained continuous abstinence from smoking, and their self-reported status at 1 year was verified biochemically.

A comprehensive model for the treatment of nicotine dependence in a medical setting

We have summarized the basic components of a comprehensive model for the treatment of nicotine addiction in a medical setting. It is a labor-intensive program with emphasis on individual assessment and the development of individual treatment programs adaptable to all levels of nicotine dependence. We anticipate that this model will be increasingly used by medical centers in the future. As more traditional programs successfully treat the less severely nicotine-dependent patients, more severely dependent smokers are left in need of more intensive services. We have already begun to see this trend in our practice, requiring more counselor time for individual follow-up and referral into our group therapy programs. Adjunctive pharmacologic therapy is an exciting and promising area, but best results include associated behavioral intervention. Reimbursement remains a major impediment to patient involvement in many of these programs. This impediment will be overcome when third-party payers begin to cover these services as endorsed by the Surgeon General and the United States Department of Health and Human Services.

An integrated approach to the treatment of nicotine dependence in a medical center setting: description of the initial experience

A nicotine-dependence treatment program can be implemented in a medical center setting by using a model that involves physician, patient, and nicotine-dependence counselor. The physician-referred and counselor-directed consultations are followed by a systematic relapse-prevention program. The counselors utilize behavioral approaches, the philosophy and principles of the addictive disorders field, and adjunctive pharmacologic therapy. The patients are chronic, heavy smokers who have had many previous quit attempts and are highly nicotine-dependent. Important factors include: 1) referral by physicians, 2) physicians' active role in the intervention, 3) expertise of the counselors, 4) structured relapse-prevention program, and 5) provision of services in a smoke-free medical center.