Arthur J. Garvey

Urges to smoke during the first month of abstinence: relationship to relapse and predictors

The urges to smoke reported by 215 former smokers were measured 1 day, 7 days, 14 days and 30 days after they quit to examine: (a) the time course of smoking urges, (b) the relationship of urges to relapse, and (c) predictors of urges to smoke. Urges to smoke were strongest 1 day after quitting, and decreased at each subsequent measurement point. Urges were a powerful predictor of relapse. At each of the four assessment points, abstinent subjects who reported stronger urges to smoke were more likely to relapse by the next measurement point. Urges to smoke at a given day (e.g., day 1) were consistently the best predictors of the persistence of urges at the next assessment (e.g., day 7). Greater negative emotion (e.g., anxiety, sadness, anger, and confusion) and psychosocial stress also predicted stronger urges to smoke. Nicotine gum significantly reduced urges during week 1 post-cessation. Clinical implications of the findings are discussed.

Gender differences in the outcome of an unaided smoking cessation attempt

There is conflicting evidence concerning gender differences in success at quitting smoking. Information is especially lacking regarding gender differences among unaided quitters who make up the vast majority of those attempting to quit. One hundred thirty-five smokers who made an unaided attempt at quitting were interviewed before quitting and were followed for 1 year after cessation. Relapse rates were extremely high both for men and women, with 62% of participants returning to regular smoking within 15 days after cessation. Women and men were equally likely to maintain short-term abstinence (through 15 days), but women were more than three times as likely to relapse subsequently. Nine percent of men, but no women, had biochemically verified sustained abstinence throughout the 1-year follow-up period. For both men and women, any smoking after the quit attempt inevitably led to full-blown relapse. Most participants resumed regular smoking within 24 hours after the first episode of smoking. Gender differences were observed for several variables related to smoking history, demographics, social support, perceived stress, and motivational factors, but these differences did not explain the increased risk of relapse for women. Our results clearly indicate that women are less likely than men to maintain long-term smoking abstinence following an unaided quit attempt, but reasons for this gender difference need further exploration.

Smoking, Smoking Cessation, and Tooth Loss

Smoking is associated with an increased risk of tooth loss, but it is not known if this risk decreases significantly when individuals quit smoking. The objectives of this study were to describe the rates of tooth loss by smoking status in two populations of medically healthy men and women. Among the men, rates of tooth loss and edentulism in relation to smoking cessation were also evaluated. The subjects were drawn from a group of 584 women (aged 40 to 70) recruited from the Boston, MA, area and a separate population of 1231 male veterans (aged 21 to 75) who participated in the VA Dental Longitudinal Study in Boston. In cross-sectional baseline analyses, current cigarette smokers of either sex had significantly more missing teeth than never-smokers or former smokers. Former smokers and pipe or cigar smokers tended to have an intermediate number of missing teeth. Current male smokers had more teeth with calculus, but the differences in plaque, tooth mobility, probing depth > 2 mm, filled and decayed teeth, and bleeding on probing by smoking history were not significant. Prospective observations of 248 women (mean follow-up time = 6 ± 2 years) and 977 men (mean = 18 ± 7 years) indicated that individuals who continued to smoke cigarettes had 2.4-fold (men) to 3.5-fold risk (women) of tooth loss compared with non-smokers. The rates of tooth loss in men were significantly reduced after they quit smoking cigarettes but remained higher than those in non-smokers. Men who smoked cigarettes had a 4.5-fold increase in risk of edentulism, and this risk also decreased upon smoking cessation. These findings indicate that the risk of tooth loss is greater among cigarette smokers than among non-smokers. Smoking cessation significantly benefits an individuals likelihood of tooth retention, but it may take decades for the individual to return to the rate of tooth loss observed in non-smokers.

Smoking relapse after 2 years of abstinence: findings from the VA Normative Aging Study

Little is known about the risk of cigarette smoking relapse after 2 or more years of abstinence. The rates and predictors of late smoking relapse were estimated in 483 men who participated in a prospective study for up to 35 years. Subjects are participants in the VA Normative Aging Study, a prospective observational study of aging in men that began in 1963. Subjects are evaluated approximately every 3 years with physical examinations and questionnaires. Smoking, alcohol use, caffeine consumption, and socioeconomic variables were obtained by questionnaire, and weight and height were measured at clinical examinations every 3 years since 1963. Predictors of smoking relapse were identified using proportional hazards regression models. The rate of smoking relapse in the 2nd-6th years of abstinence fluctuated between 2 and 4% per year, and fell to less than 1% only after 10 years of abstinence. In multivariate regression models, coffee and alcohol consumption, and use of cigars or pipes significantly increased the risk of smoking relapse. A small risk of smoking relapse remains for at least 10 years after smoking cessation. Use of other tobacco products, coffee and alcohol increased the risk of late relapse. These findings may be useful in identifying those at highest risk for late relapse and for motivating former smokers to continue long-term abstinence.

The Influence of Situation and Coping on Relapse Crisis Outcomes after Smoking Cessation.

Examines the influence of situational characteristics and coping on the outcome of a relapse crisis for 232 Ss followed for 1 month after a self-initiated smoking cessation attempt. Survival of a relapse crisis was most strongly related to the number of coping strategies used. All coping strategies were equally effective; furthermore, combining cognitive and behavioral coping strategies was not more effective than using multiple cognitive or multiple behavioral strategies. During the second half of the follow-up period (Weeks 3 and 4 postcessation), the presence of smokers resulted in a decreased likelihood of coping and an increased likelihood of smoking. In addition, active coping was marginally related to higher baseline levels of motivation to quit. When motivation and the presence of smokers were controlled, however, coping still significantly predicted outcome. Results are discussed with reference to previous relapse studies.

The influence of gender, race, and menthol content on tobacco exposure measures.

Research has suggested that race, gender, and menthol cigarette use influence tobacco-smoke exposure measures and smoking-related disease risk. For example, a high proportion of Black smokers prefer menthol cigarettes and, despite smoking fewer cigarettes per day (CPD) than do Whites, tend to have higher cotinine levels. Additionally, Black males are more at risk for smoking-related lung cancer. High cotinine levels and smoking menthol cigarettes may lead to higher toxin intake, which contributes to increased disease risk. We explored the relationship between tobacco exposure variables (i.e., cotinine, CPD, carbon monoxide [CO], nicotine content, and nicotine dependence) with respect to race, gender, and menthol content in a sample of 307 smokers recruited from the greater Boston area to participate in a smoking cessation treatment trial. The pattern of correlations between tobacco exposure measures and cotinine showed a consistently positive correlation between cotinine and CO in all smokers and a correlation between cotinine and CPD in those who smoked nonmenthol cigarettes. Cotinine and CPD correlations varied by gender and race among menthol cigarette smokers. Consistently, we found a significant gender x race x menthol interaction on salivary cotinine level as well as cotinine/CPD ratio. These findings suggest that the relationship between number of cigarettes consumed and salivary cotinine is more complex than previously believed. It is not sufficient to look at race alone; researchers and clinicians need to look at race and gender concurrently, as well as type of cigarette consumed.

Effects of nicotine gum dose by level of nicotine dependence

We used the Heaviness of Smoking Index, a subset of the Fagerstrom Test for Nicotine Dependence, to classify 608 cigarette smokers planning a cessation attempt as low or high in nicotine dependence. Subjects within each level of dependence were then randomly assigned to placebo, 2-mg, or 4-mg nicotine gum treatment. Subjects were also provided brief (5-10 min per visit) behavioral counseling during a 1-year period of follow-up. At 1 year post-cessation, quit rates were 11.2, 19.5, and 18.4% for low-dependence smokers receiving placebo, 2-mg, and 4-mg gum, respectively (plinear trend = 0.20). For high-dependence smokers, quit rates at 1 year were 6.1, 15.7, and 20.7% for the placebo, 2-mg, and 4-mg gum conditions, respectively (plinear trend = 0.002). The interaction of nicotine-gum dose and dependence group was not significant (p = 0.42), nor did the 2-mg and 4-mg doses differ significantly in effectiveness, though both 2-mg and 4-mg gum were significantly more effective than placebo gum. We also found a significant dose-related effect for nicotine gum to moderate post-cessation heart-rate decline. Other variables related to abstinence at 1 year post-cessation were a longer period of abstinence on a prior quit attempt, being married, higher education level, and having a non-smoking spouse or significant other. Results indicate that nicotine gum is a significant aid to smoking cessation, more than doubling the odds of successful cessation compared to the odds for placebo-gum users. The 4-mg dose provided a non-significant increase in cessation rates for high-dependence smokers. Smoking history and demographic variables also have a significant impact on the outcome of a quit-smoking attempt.

Smoking, Weight Change, and Age

This study examined a cohort of healthy white veterans during a five-year period in order to determine the effects of age and of change in smoking status on change in body weight. In general, regardless of age cohort, a greater number of excigarette smokers gained weight, more weight than did other men. However, excigarette smokers between the ages of 40 and 54 years old showed a substantial weight gain when, according to National Health Survey statistics, men in that age span normally gain little weight. While both chronological age and cigarette smoking change were significantly related to weight change, together they accounted for only 7.5% of the variance in weight change, suggesting the importance of other factors in explaining the weight change over a five-year period.

Predictors of Weight Change Following Smoking Cessation

Smoking behavior and weight change over a 5-year period were studied in 1,749 adult males of the Normative Aging Study. While men who quit smoking generally gained more weight than those in other smoking categories, 36% either lost weight or maintained the same weight after quitting. The major research focus was to predict the direction of weight change after smoking cessation. Among the characteristics most related to weight gain after quitting were heavier tar consumption, younger age, and leanness of body build. Conversely, traits related to weight loss were lighter smoking, older age, and stoutness of build.

Factors in predicting blood pressure change.

A total of 1166 male participants (ages 23–80 years) of the Normative Aging Study who had baseline blood pressure less than 140/90 mm Hg were followed prospectively for 10 years. Blood pressures were taken at 5- and 10-year follow-up examinations. Multiple linear regression analysis indicated that baseline levels of systolic pressure, hematocrit, subscapular skinfold thickness and age were significant predictors of systolic pressure change during the follow-up period. Baseline levels of diastolic pressure, hematocrit, and body mass index were significant predictors of diastolic pressure change. Multiple logistic regression analysis revealed that only baseline blood pressure and hematocrit were significant predictors of subsequent blood pressure elevation to more than 159 mm Hg systolic or 94 mm Hg diastolic. Although the mechanisms by which hematocrit and body build affect blood pressure are unknown, these results suggest that identifying hypertension-prone subjects and delaying or preventing hypertension may be possible.