Counseling nondaily smokers about secondhand smoke as a cessation message: a pilot randomized trial.

INTRODUCTION: Nondaily smoking represents a substantial and growing fraction of smokers, many of whom do not consider themselves smokers or at risk of tobacco-related diseases and, so, may be less responsive to counseling content contained in traditional cessation interventions. This study compares the effects brief counseling interventions (<20 min) focused on the harm smoking does to themselves (harm to self, HTS) versus the harm their secondhand smoke (SHS) does to others (harm to others, HTO) among nondaily smokers. METHODS: Randomized trial of 52 nondaily smokers (smoked in the past week, but not daily) recruited between September 2009 and June 2010; 40 completed the study. We measured changes in motivation and smoking status at 3 months postintervention. RESULTS: There was a difference in quitting between the two groups, with 9.5% (2 out of 21) for HTS and 36.8% (7 out of 19) for HTO subjects reporting not smoking any cigarettes in the prior week (p = .06 by Fisher exact test and .035 by likelihood-ratio chi-square). Motivation and self-efficacy increased from baseline to 3-month follow-up, but not differentially by intervention group. CONCLUSIONS: Consistent with findings from research conducted by the tobacco industry as early as the 1970s that concluded that social smokers feel immune from the personal health effects of tobacco but are concerned about the consequences of their SHS on others, educating nondaily smokers about the dangers of SHS to others appears to be a more powerful cessation message than traditional smoking cessation counseling that emphasizes the harmful consequences to the smoker.

Social smoking implications for public health, clinical practice, and intervention research.

BACKGROUND: Social smoking is increasingly prevalent and poses a challenge to traditional cessation practices. Tobacco companies conducted extensive research on social smokers long before health authorities did and marketed products to promote this smoking behavior. PURPOSE: Research is described and mechanisms identified that are used to promote social smoking to help improve cessation strategies in this growing group. EVIDENCE ACQUISITION: Searches from 2006 to 2008 of previously secret tobacco industry documents using keywords social smoker, light smoker, casual smoker, youth smoker, and occasional smoker, followed by snowball searching. Data analysis was conducted in 2008. EVIDENCE SYNTHESIS: Tobacco industry research identified characteristics of social smokers that include: (1) denial of personal nicotine addiction; (2) self-categorization as a nonsmoker; (3) propensity for decreased tobacco use in response to smoke-free laws; (4) variations in age, education, ethnicity, and socioeconomic backgrounds; and (5) a perceived immunity to personal health effects of tobacco but fear of consequences to others. Tobacco companies developed marketing strategies aimed at social smokers, including "non-habit forming" cigarettes. CONCLUSIONS: Previously considered a transient behavior, social smoking is also a stable consumption pattern. Focused clinical questions to detect social smoking are needed and may include, "Have you smoked any cigarettes or used any tobacco products in the past month?" as opposed to "Are you a smoker?" Clinicians should recognize that social smokers might be motivated to quit after education on the dangers of secondhand smoke rather than on personal health risks or with pharmacotherapy.

Prevalence and risk factors for depressive symptoms in persons with chronic obstructive pulmonary disease.

BACKGROUND: Although depression is a risk factor for adverse outcomes in chronic illness, little is known about the prevalence or risk factors for depressive symptoms in chronic obstructive pulmonary disease (COPD). OBJECTIVE: To determine the prevalence of depressive symptoms in COPD as compared to other chronic illnesses and to identify risk factors for depressive symptoms in COPD. DESIGN AND PATIENTS: Cross-sectional study of 18,588 persons (1,736 subjects with self-reported COPD), representing a sample of the US population aged > or =50 years who participated in the 2004 Health and Retirement Survey. MEASUREMENTS: Presence of COPD and other chronic conditions was defined by self-report. Presence of depressive symptoms was assessed using the CES-D8 scale. Participants with a score > or =3 on CES-D8 were classified as having clinically significant depressive symptoms. MAIN RESULTS: Of 1,736 participants with COPD, 40% had > or =3 depressive symptoms. Depressive symptoms were more common in COPD than in coronary heart disease, stroke, diabetes, arthritis, hypertension, and cancer. Risk factors for > or =3 depressive symptoms in COPD: younger age (OR 1.02/per year younger, 95% CI [1.02-1.03]), female gender (1.2 [1.1-1.3]), current smoking (1.5 [1.3-1.7]), marital status [divorced/separated (1.8 [1.6-2.1]), widowed (1.8 [1.6-2]), never married (1.4 [1.1-1.8]), < or =high school degree (1.6 [1.5-1.8]), dyspnea (2.3 [2.1-2.6]), difficulty walking (2.8 [2.5-3.2]), and co-morbid diabetes (1.2 [1.1-1.4]), arthritis (1.3 [1.2-1.5]) or cancer (1.2 [1.1-1.4]). CONCLUSIONS: Depressive symptoms are common in COPD and are more likely to occur in COPD than in other common chronic illnesses. The risk factors identified may be used for targeted depression screening in COPD patients.