Comparative Analysis of Alternate Measures of Readiness to Quit Smoking: Stages of Change and the Contemplation Ladder.

Purpose: Two methods of operationalizing readiness to quit smoking have been used extensively in prior research. An algorithm derived from the transtheoretical model classifies current smokers in distinct stages of precontemplation (not intending to quit in next 6 months), contemplation (serious intent to quit within 6 months), and preparation (serious intent to quit within 30 days). The Contemplation Ladder (CL) is a single-item continuous (0-10) rating. The current study, a secondary analysis of a clinical trial testing a method of inducing quit attempts, examined the convergent validity, one-month retest reliability, and predictive validity (for quit attempts) of the CL and the stages of change algorithm. Patients and Methods: Adult daily smokers (≥10 cigarettes/day; N = 278) completed the CL and stage of change algorithm measures and underwent an experimental manipulation intended to induce quit attempts. Four weeks later they completed the same measures and reported on whether they had attempted to quit smoking in the interim. Results: The CL and the staging algorithm showed strong convergent validity, with intercorrelations of 0.50 and 0.51 at baseline and follow-up assessments. Retest reliability was similar for each measure (CL r = 0.52; stage of change r = 0.57). Each showed predictive validity in that smokers who went on to make a quit attempt had scored significantly higher at baseline in readiness to quit. Conclusion: Researchers and clinicians can reasonably choose either measure of readiness to quit smoking with confidence that the results would parallel what would have been obtained with the other.

Modifying outcome expectancies and behavioral reinforcers to induce quit attempts among young adult smokers.

Research has shown that outcome expectancies predict smoking behavior, and expectancy challenge interventions can reduce smoking. This study tested the hypothesis that supplementing expectancy challenge with a behavioral activation intervention promoting increased exposure to alternative reinforcers would help increase motivation to quit and induce actual quit attempts within the following month among young adult smokers. Smokers, aged 18-35 (N = 159, of whom 93 provided one-month follow-up data) and not required to be interested in quitting at the point of enrollment, were randomized to (a) the combined cognitive-behavioral intervention, (b) a cognitive-only expectancy challenge, or (c) a neutral reading (control) task. There were no significant between-group effects on motivation, but the conditions differed significantly in likelihood of leading to a quit attempt. Post hoc comparisons showed the combined condition participants (52 % of completers) to be significantly more likely than control group participants (25 %) to make a quit attempt, with the cognitive-only group (43 %) intermediate and not significantly different from the other conditions. These data provide preliminary evidence of utility for the brief cognitive-behavioral intervention in promoting smoking cessation attempts; more research is needed to test various possible explanations of how and for whom the intervention is effective, as well as whether it would significantly exceed expectancy challenge alone in larger samples.

Looming Vulnerability and Smoking Cessation Attempts.

INTRODUCTION: The looming vulnerability model holds that people become anxious when they perceive threats as growing larger and accelerating toward them in space and time. Preliminary research suggested that a guided imagery induction designed to activate a sense that health consequences of smoking are a looming threat led more smokers to attempt to quit. This study tested the effect on quit attempts in a larger sample and examined age, sex, and sensation seeking as moderators. AIMS AND METHODS: Adult smokers (≥10 cigarettes/day) screened for risk of anxiety or mood disorders (N = 278, 52% male; 77% African American) were randomly assigned to receive (1) looming vulnerability or (2) neutral guided imagery exercises. At a 4-week follow-up, they reported quit attempts, smoking rate, self-efficacy, outcome expectancies, and contemplation status. RESULTS: Those in the looming condition (17%) were no more likely than those in the control condition (20%) to make a quit attempt. There were no significant group differences in expectancies, contemplation, or follow-up smoking rate, and no significant moderators. CONCLUSIONS: The looming induction was the same one used in earlier work in which it had stronger effects. Those who respond to it with increased urgency about quitting smoking might be offset by others who are more reactant and deny the message. Inconsistencies across studies may reflect differences in inclusion criteria, such that the present sample was on average heavier smokers with longer smoking history and more severe nicotine dependence, yet higher self-efficacy. IMPLICATIONS: An induction designed to activate a sense that the health consequences of smoking constitute a looming vulnerability failed to increase quit attempts or reduce smoking rate among adult daily smokers. Inconsistencies across studies might reflect varying sample characteristics resulting from changes in screening criteria.

Examining outcome expectancies for smoking vs. abstinence among adult daily smokers.

In a motivational interviewing (MI) framework of decision-making, we consider potential outcomes for both a primary choice and an alternative choice (DiClemente & Velazquez, 2002). Thus, we would expect that motivation to quit smoking is related to expectancies for quitting smoking and expectancies for continuing to smoke. While smoking expectancies have been frequently studied, less attention has been paid to abstinence expectancies. The present study sought to clarify the predictive utility of smoking and abstinence expectancies together for smoking motivation and behavior, versus measuring smoking expectancies alone. Expectancies were measured at baseline; outcomes were measured at baseline and one-month follow-up. Smoking expectancies were assessed via the Smoking Consequences Questionnaire-Adult (Copeland, Brandon, & Quinn, 1995), and abstinence expectancies were assessed via the Perceived Risks and Benefits of Quitting scale (McKee, O'Malley, Salovey, Krishnan-Sarin, & Mazure, 2005). Outcomes included motivation to quit (Contemplation Ladder, Biener & Abrams, 1991; Stage of Change, DiClemente et al., 1991), and average daily smoking rate. Data was analyzed for 183 smokers at baseline and 166 at follow-up. Baseline smoking expectancies and abstinence expectancies were each uniquely associated with concurrent motivation to quit, but not concurrent smoking rate. Abstinence expectancies uniquely predicted changes in smoking rate over time. Smoking and abstinence outcome expectancies may relate differently to smoking behavior, motivation to quit, and changes in these constructs over time.

Development and validation of the cigarette smoking consequences looming scale.

INTRODUCTION: Experimental manipulations intended to alter cognitive appraisals of smoking-related threats may affect cigarette smoking and motivation to quit. However, no previous measure has directly assessed perceptions of smoking-related threats as increasing and coming closer in space and/or time (i.e., "looming"). The current research develops such a measure of dynamic smoking-related threat appraisal: the Cigarette Smoking Consequences Looming Scale (CSCLS). METHODS: In Study 1 (N = 124 daily smokers), the researchers created an initial, scenario-based version of the CSCLS and refined the measure based on factor analysis. In Study 2, 143 daily smokers completed a condensed CSCLS organized around two factors (Physical and Social consequence of smoking). In each study, participants also completed measures of dispositional looming perception, motivation to quit smoking, and smoking outcome expectancies. RESULTS: The CSCLS showed strong internal consistency and concurrent validity in that scores on the measure correlated as expected in both studies with a general tendency to perceive threats as looming, outcome expectancies for smoking, and motivation to quit smoking. CONCLUSIONS: Measuring perceptions of smoking-related consequences as looming may provide greater insight into the cognitive factors associated with motivation to quit smoking, which in turn may inform communications about the risks of smoking.

Nicotine Replacement, Topography, and Smoking Phenotypes of E-cigarettes.

OBJECTIVES: Little is known about the degree of nicotine replacement across first-generation e-cigarette brands, how e-cigarettes are used, and if there is variation across brands in relevant smoking phenotypes. The objective of this project was to collect data that are critical to better understanding, use, and exposure when using e-cigarettes, which may then inform clinical trials and tobacco regulatory policy. METHODS: Twenty-eight cigarette smokers were randomized to use one of 5 popular brands of e-cigarettes for a 10-day study. Day 1 (own cigarette brand) data established baseline levels for cotinine, carbon monoxide (CO), topography, cigarette liking, withdrawal, and craving. Participants returned on Days 5 and 10 to reassess these measures while exclusively using e-cigarettes. RESULTS: Compared to cigarette smoking, e-cigarettes provided significantly lower nicotine levels (25%-50%), reduced CO exposure, and lower ratings of liking (p < .05). Topography significantly differed between cigarette and e-cigarette sessions (p < .05). All brands significantly reduced withdrawal and craving (p < .05). There were no significant brand differences in outcome measures associated with exposure or use. CONCLUSIONS: E-cigarettes are not liked as much as cigarettes, provide significantly lower nicotine replacement, reduce CO exposure, and mitigate withdrawal and craving. The patterns of use significantly differ compared to cigarette smoking.

Rate of nicotine metabolism and smoking cessation outcomes in a community-based sample of treatment-seeking smokers.

BACKGROUND: In samples from controlled randomized clinical trials, a smoker's rate of nicotine metabolism, measured by the 3-hydroxycotinine to cotinine ratio (NMR), predicts response to transdermal nicotine. Replication of this relationship in community-based samples of treatment-seeking smokers may help guide the implementation of the NMR for personalized treatment for nicotine dependence. METHODS: Data from a community-based sample of treatment seeking smokers (N=499) who received 8weeks of transdermal nicotine and 4 behavioral counseling sessions were used to evaluate associations between the NMR and smoking cessation. Secondary outcomes included withdrawal and craving, depression and anxiety, side effects, and treatment adherence. RESULTS: The NMR was a significant predictor of abstinence (OR=.56, 95% CI: 0.33-0.95, p=.03), with faster metabolizers showing lower quit rates than slower metabolizers (24% vs. 33%). Faster nicotine metabolizers exhibited significantly higher levels of anxiety symptoms over time during treatment, vs. slower metabolizers (NMR x Time interaction: F[3,357]=3.29, p=.02). NMR was not associated with changes in withdrawal, craving, depression, side effects, and treatment adherence (p's>.05). CONCLUSIONS: In a community-based sample of treatment-seeking smokers, faster nicotine metabolizers were significantly less likely to quit smoking and showed higher rates of anxiety symptoms during a smoking cessation treatment program, vs. slower nicotine metabolizers. These results provide further evidence that transdermal nicotine is less effective for faster nicotine metabolizers and suggest the need to address cessation-induced anxiety symptoms among these smokers to increase the chances for successful smoking cessation.