Smoking Cessation

The first article for review is titled Self-efficacy, Health Locus of Control, and Smoking. This article studies how the participants confidence levels and health locus prior to entering treatment predicts results of the quitting program. The program is called "Fresh Start" and was conducted in Victoria, Australia. It consisted of three groups: (A) those who made an attempt (Stop for one day), (B) those who met criteria in A, and did not smoke for duration of program, (C) those who abstained for six months. Confidence was tested by questionnaires (post, during and at 6-month period). Health Locus is defined by how the participant attributed health outcomes (internal, external or by chance). The results of this experiment showed that those individuals across the three groups who had high levels of self-efficacy was related not to the number of attempts to quit, but the success of the attempts, while "the role of Health Locus of Control [was found to be] complex needing further investigation" (Stuart, Borland, & McMurray, 1994, p. 1). The second article for review is titled, Sensation Seeking, Nicotine Dependence, and Smoking Motivation in Female and Male Smokers. This study was conducted using a sample of French smokers (36 F, 60 M) and non-smokers (23 F, 45 M). The goal of the experiment was to study "the relationship between sensation seeking and smoking" (p. 221). The objectives of the study was (a) to see if smokers are higher in sensation seeking than their non-smoking counterparts, (b) to see if there are any gender forces in smoking and sensation seeking, and (c) to examine "in each sex, the nature of the relationship between sensation seeking and smoking" (p. 221). These three items were measured on four sub-scales, they are: 1) The Disinhibition subscale (DIS) - shows desire to be socially open, extroverted 2) The Thrill and Adventure Seeking subscale (TAS) - shows desire, extreme physical activities. 3) The Experience Seeking subscale (ES) - shows search for new and exciting life experiences. 4) The Boredom Susceptibility subscale (BS) After the evaluation of multiple questionnaires was completed, results of the subscale analysis was as follows: (a) Smokers score higher in sensation seeking regardless of sex, than non- smokers. (b) Women scored higher scores than men in the ES subscale (trend). (c) Men scored higher on AIS and TAS scale than women. (d) ES and BS subscales had a significant main effect for smoking status. This study concludes by showing "that smokers score higher on measures of sensation seeking than do non-smokers" (p. 224). This aids the belief that sensation seekers may be more open to become dependant on smoking, as opposed to those who score low on sensation seeking activities. Finally, women scoring higher on the ES subscale, was attributed to mass media and emerging cultural trends that have lured more women to be independent and more experience seeking than in the past. The next article in the subject of smoking is titled Measuring Readiness and Motivation to Quit Smoking Among Women in Public Health Clinics. This study was a pilot program to test as an instrument in the stage readiness and motivation of 495 women of lower socioeconomic class in Chicago. Since this segment of the smoking population has not declined when other have, it reveals the reasoning behind the study and therefore it is necessary to "develop and validate an instrument to measure progress across all stages of readiness" (p. 497) to aid motivation. The instrument spoke of is a questionnaire by Diclemente, et al., (1991) and Prochaska, et al. (1992), modified to meet the literacy level of female subjects of the lower socioeconomic level. The questionnaire was given to smokers "in prenatal, family planning, and well-child health clinics" (p. 498). The stages of Prochaska and Diclemente's were expanded to ensure sensitivity because most of the women of low SES fell into the first category; precontemplation (no intent to quit smoking in the next 6 months). The experimenters, therefore, "were interested in measuring movement within the early stages of change" (p. 498). Through the use of Biener and Abrams (1991) contemplation ladder, the experimenters were able to make this expansion. The experiment also evaluated other variables, they were: "smoking status, age, education level, pregnancy status, and type of clinic" (p. 501). Results of this newly formed instrument to detect finer movement across the precontemplation stage of readiness yielded the following: (a) "Readiness was higher for women who were pregnant" (p. 505). (b) Higher readiness equalled higher motivation, confidence, and action. (c) Stages unrelated to other variables (age, education, stress, or race). (d) Stages of readiness to quit was negatively related to habitation factors (p. 506). This experiment concludes by stating there instrument meets the low literacy needs of low SES women and that the instrument has shown sensitivity and reliability "to track the movement of motivation and readiness to quit in such a group" (p. 506). The fourth article for summary is Cigarette Smoking: Effects Upon Self-Rated Stress and Arousal Over the Day. This experiment dealt with the "typology" of smokers. Its main objective was to find evidence that contradicts the arousal modulation theory of smoking. Subjects were divided into two groups; smokers that smoked for arousal and those who smoked for sedative reasons. The experiment was done over the course of one day, which was divided into four time blocks; first cigarette = first time block, while last cigarette of the day was the fourth time block (rest of the day was divided into blocks 2 and 3). Subjects made self reports before and after each cigarette for that day. For subjects in the stress group, stress was high before each cigarette and decreased afterward, increasing again prior to the next cigarette (cyclicle pattern). Subjects in the arousal group over the day yielded an increase in arousal in block one, that increased gradually until high in later afternoon, then decreasing at night. These outcomes lend support to the theory that the main problem with the arousal modulation theory "is the linkage of stress and arousal" (p. 394). This study provided "an alternative viewpoint: that stress control and arousal control are separate and orthogonal" (p. 395), and research into sub-groups of smokers is needed. Attributional Correlates of Cessation Self-Efficacy Among Smokers was an experiment designed to examine the association of past failed attempts at quitting smoking, with Self- Attribution and Self-efficacy. One hundred and twenty-one male and female subjects who were seen smoking at a small campus or mall were asked to complete an open-ended questionnaire concerning the subject at hand. The questionnaire was designed to elicit information for the following categories: (1) Demographic and historical data. (2) Attributional statement and dimensional ratings. (3) Composite attributional indices. (4) Cessation self-efficacy. Results from the open-ended attribution questionnaire found "three main categories: personal factors, situational factors, and combined personal and situational factors" (p. 315). Analysis of these categories and sub-categories suggest "that attributional processes are related to cessation among smokers" (p. 317). Smokers who were confident in future quit attempts, attributed past failures to unstable and/or controllable factors; while those with low confidence, attributed past failure to stable and/or uncontrollable factors. The main factors to help explain failed attempts at cessation were self-blame, perceived ideas concerning past failures and having family/friends who smoke. The experimenters conclude by suggesting that therapists should "focus on the similarities" (p. 319) of different models of attribution to create therapies that aid in helping clients to "[attribute] abstinence failures to changeable, controllable factors" (p. 319) which based on their findings increase the self-efficacy of smokers. The last article is a study of self quitters by H.J. Garney, et al. that followed 235 people who quit smoking on self intuitive alone, for a period of twelve months. The project was run through to determine what factors caused the participants to fail in their attempt to quit smoking. More importantly, the study looks at the post-quitting period, not as a single entity, but as several critical time frames of said post-quitting period. The number of people who relapse is quite high among those who used self-quitting techniques is why this study is important. It sheds light in the areas of the scientific study of the addictive habit of cigarette smoking and it provides many useful and helpful hints to those who have previously failed in their attempts to stop smoking. The purpose of this study, as stated by its authors is as follows: "to provide prospective information on predictors of early and later relapse for smokers who made a self-initiated quite attempt" (p. 365). From 251 subjects, 235 were chosen and each initiated their quit attempt four days after a baseline was taken. Each subject, whether they were successful in their attempt or fell prey to relapse, were kept in contact with the experimenters through telephone or personal interviews to monitor the subjects status and to ask questions concerning their difficulties. The study's baseline measured the subjects on many variables, such as; level of motivation, confidence, and psychological stress. It also observed personal variables like, the smoker's history, demographics, environment and lifestyle. An interview schedule in conjunction with various tests (ex., Smoking Test Patterns, Russel, et al., 1974) and electronic equipment to measure carbonmonoxide levels were used to generate the baseline accurately. Follow up measures included getting information from subjects concerning their productivity after quitting smoking, at the one month mark. If they relapsed at all, or if they had abstained from smoking how their attitudes were on psychological stress, confidence to remain abstinent, as well as frequency and strength of temptations to smoke. These follow up measures were used again at the 3 month mark, and at the 12 months mark for those who were still able to abstain. Carbonmonoxcide levels and saliva samples were tested to verify subject's claims of abstinence. The projects definition of "relapse" is an important note here, it is as follows: "relapse was defined as 7 or more consecutive days of smoking, or 7 or more consecutive episodes of smoking" (p. 369). At the 12-month follow up only 12.8% of the sample population of 235 subjects managed not to fall into relapse. For those who relapsed, results indicate that the greatest amount of relapse occurred by the first two weeks of post-self-quitting. The percentages of relapses in the first two weeks are: 13% - day 1 32% - by day 3 49% - by week 1 62% - by week 2 The relapses increase to 76% at the end of month one, and then levels off finally at 87.2% between months one and twelve. From the results obtained an analysis was done to find which baseline predictors had the strongest effect on relapse. The relapse times were divided into four categories: Abstains during: a) 0-7 days; b) 8-30 days; c) 31-364 days and d) at 365 days (* groups A, B and C did not make it to 365 days abstinence). Outcomes revealed the following: (most significant at the top of the list and decreasing effect as the list goes down). (a) not quitting as long as you did the last time you tried to quit. (b) lower motivation to quit. (c) lower confidence to quit for 3 months. (d) have a spouse/significant other who smokes. (e) greater alcohol consumption than baseline. Multivariant results compared groups A, B, and C individuals with group D (those who abstained for 365 days). The most significant baseline predictors in descending strength are: (a) short term confidence in maintain abstinence. (b) not equalling prior longest quit time. (c) started smoking to maintain weight. In comparison, between group A and D, a person with one standard deviation higher in confidence is half as likely to start smoking again. The odds are the same for someone who does not meet or surpass their longest prior quitting duration. The weight motive differed for gender type. Women are more likely not to relapse, and men were more likely to they use the weight motive. While results for comparing groups B and C with group D have basically the same predictors of relapse; less short-term confidence and baseline alcohol consumption. This study has found that relapse in the first early weeks of cessation are higher than recent literature suggests, compared to those who attend stop smoking type clinics. Example: Self-quitters Clinic 62% vs 10% (past 2 weeks) 76% vs 20% (to 1 month) The other conclusions the study has made are: 1) It is the "length" of the prior longest quit duration and the number of times one has tried to quit is important. (If the person doesn't match longest time frame, he/she is more likely to quite due to motivation and confidence factors). 2) Attitude prior to quitting: The level of commitment, motivation and confidence are directly related to relapse. Therefore, higher levels of factors yield longer quitting times and vice versa. 3) Baseline Alcohol consumption: If a person had high levels of alcohol consumption during baseline, the person is likely to continue this practice and therefore be exposed in social settings which provide cues to smoke and he/she will be more likely to succumb to the temptation of smoking. 4) Any Smoking during cessation: Any smoking whatsoever by a person during the cessation period dramatically increases the chances of relapse. For example in this study, out of 215 who did smoke any amount at all, only 10 went on to abstain, 205 went into full relapse. In addition, the study revealed that neither age, gender, education, amount smoked, social support or increased psychological stress levels at the one month mark did not have a significant effect on relapse. And finally, clinical implication are to advise potential patients with the four main conclusions mentioned here.