Kathrin Schuck

The effects of brief cognitive-behaviour therapy for pathological skin picking: A randomized comparison to wait-list control

Thirty-four college students suffering from pathological skin picking were randomly assigned to a four-session cognitive-behavioural treatment (n=17) or a waiting-list condition (n=17). Severity of skin picking, psycho-social impact of skin picking, strength of skin-picking-related dysfunctional cognitions, and severity of skin injury were measured at pre-, post-, and two-months follow-up assessment. Participants in the treatment condition showed a significantly larger reduction on all measured variables in comparison to the waiting-list condition. The obtained effect sizes for the outcome measures were large, ranging from .90 to 1.89. Treatment effects were maintained at follow-up. In conclusion, cognitive-behavioural therapy, even in brief form, constitutes an adequate treatment option for pathological skin-picking behaviour.

Responses to environmental smoking in never-smoking children: can symptoms of nicotine addiction develop in response to environmental tobacco smoke exposure?:

A recent line of studies has brought attention to the question whether repeated exposure to environmental tobacco smoke (ETS) is capable of producing psycho-physiological effects in non-smokers and whether symptoms of nicotine dependence can develop in the absence of active smoking. Children seem to be particularly vulnerable to the effects of ETS. We examined the occurrence of psycho-behavioural symptoms, designed to assess nicotine addiction and nicotine withdrawal, in a sample of 778 never-smoking children aged 9–12 years using cross-sectional survey data collected in 15 Dutch primary schools. In the present study, 6% of never-smoking children reported symptoms of craving, 8% reported cue-triggered wanting to smoke, and 20% reported subjective symptoms in response to ETS exposure. In never-smoking children, a higher number of smokers in the child’s social environment was associated with more symptoms of cue-triggered wanting to smoke and more subjective symptoms in response to ETS. Never-smoking children and children who had initiated smoking were equally likely to report subjective symptoms in response to ETS exposure. In conclusion, environmental smoking is associated with self-reported psycho-behavioural symptoms in never-smoking children. Future research needs to investigate whether symptoms in children exposed to ETS are physiologically based or whether they reflect other characteristics which predispose youth for smoking initiation in the future.

Effectiveness of proactive telephone counselling for smoking cessation in parents: Study protocol of a randomized controlled trial

BackgroundSmoking is the worlds fourth most common risk factor for disease, the leading preventable cause of death, and it is associated with tremendous social costs. In the Netherlands, the smoking prevalence rate is high. A total of 27.7% of the population over age 15 years smokes. In addition to the direct advantages of smoking cessation for the smoker, parents who quit smoking may also decrease their childrens risk of smoking initiation.Methods/DesignA randomized controlled trial will be conducted to evaluate the effectiveness of proactive telephone counselling to increase smoking cessation rates among smoking parents. A total of 512 smoking parents will be proactively recruited through their childrens primary schools and randomly assigned to either proactive telephone counselling or a control condition. Proactive telephone counselling will consist of up to seven counsellor-initiated telephone calls (based on cognitive-behavioural skill building and Motivational Interviewing), distributed over a period of three months. Three supplementary brochures will also be provided. In the control condition, parents will receive a standard brochure to aid smoking cessation. Assessments will take place at baseline, three months after start of the intervention (post-measurement), and twelve months after start of the intervention (follow-up measurement). Primary outcome measures will include sustained abstinence between post-measurement and follow-up measurement and 7-day point prevalence abstinence and 24-hours point prevalence abstinence at both post- and follow-up measurement. Several secondary outcome measures will also be included (e.g., smoking intensity, smoking policies at home). In addition, we will evaluate smoking-related cognitions (e.g., attitudes towards smoking, social norms, self-efficacy, intention to smoke) in 9-12 year old children of smoking parents.DiscussionThis study protocol describes the design of a randomized controlled trial to evaluate the effectiveness of proactive telephone counselling in smoking cessation. It is expected that, in the telephone counseling condition, parental smoking cessation rates will be higher and childrens cognitions will be less favorable about smoking compared to the control condition.Trial registrationThe protocol for this study is registered with the Netherlands Trial Register NTR2707.

Self-efficacy and acceptance of cravings to smoke underlie the effectiveness of quitline counseling for smoking cessation

BACKGROUND Few studies have examined why smoking cessation interventions are effective. The aim of this study was to examine the mediating processes underlying the effectiveness of cessation counseling administered by the Dutch national quitline. METHODS Data were used of a two-arm randomized controlled trial in which smoking parents, who were recruited through primary schools in The Netherlands, received either quitline cessation counseling (n=256) or a self-help brochure (n=256). The endpoint was 6-months prolonged abstinence at 12-months follow-up, with 86.7% outcome data retention. Putative psychological mediators of treatment effectiveness included smoking-related cognitions (positive smoking outcome expectancies, self-efficacy), emotions (negative affect, perceived stress, depressive symptoms), and smoking cue coping methods (avoidance coping, acceptance coping) assessed at 3-months post-measurement. RESULTS Quitline cessation counseling significantly decreased positive smoking outcome expectancies and negative affect and increased self-efficacy to refrain from smoking, avoidance of external cues to smoking, and acceptance of internal cues to smoking compared to self-help material. Increased self-efficacy to refrain from smoking in stressful and tempting situations (p<.001) and increased acceptance of cravings to smoke (p<.001) significantly mediated the effect of quitline cessation counseling on prolonged abstinence at 12-months follow-up (explained variance: 25.1%). CONCLUSIONS Self-efficacy to refrain from smoking and acceptance of cravings represent an important source of therapeutic change in smoking cessation counseling.

Bidirectional Influences Between Parents and Children in Smoking Behavior: A Longitudinal Full-Family Model

BACKGROUND The present study investigated longitudinal associations and bidirectional influences between family members in smoking behavior using a longitudinal full-family design. Family systems provide a powerful social context in which modeling and imitation take place. In current literature, however, bidirectional associations between parents and children in smoking behavior are seldom considered. METHODS Participants were 426 families, including mothers, fathers, and 2 adolescent children. Associations were assessed over 5 waves with yearly intervals using a cross-lagged model in structural equation modeling. RESULTS Findings demonstrate that families resemble an interactive system affording smoking contagion across family members. Results suggest that associations between parents and children are bidirectional, that is, parental smoking behavior influences adolescent smoking behavior and adolescent smoking behavior influences parental smoking behavior. There is insufficient evidence to conclude that longitudinal associations between family members are generally bidirectional, as only unidirectional longitudinal associations were found between between siblings and partners. CONCLUSIONS The present study extends previous research on the intergenerational transmission of smoking behavior by demonstrating bidirectional influences between parents and children in smoking behavior. Moreover, the present study suggests that family members may be susceptible to adjust their smoking behavior across time in response to smoking behavior within the family.

Initial responses to the first dose of nicotine in novel smokers: The role of exposure to environmental smoking and genetic predisposition

Background: Sensitivity to initial smoking constitutes an early predictor of the risk of dependence. We investigated the role of exposure to smoking (by parents, siblings, and peers) and reward-related candidate gene polymorphisms (OPRM1 A118G, DRD2 TaqlA and DRD4 bp VNTR) in adolescents’ responses to initial smoking. Methods: We used cross-sectional survey data and saliva samples from 171 Dutch students who had never inhaled on a cigarette (mean age: 13.9 years). The outcome measure was adolescents’ self-reported responses to initial smoking. Results: Exposure to peer smoking was associated with increased liking (OR = 1.74, CI = 1.13–2.70) and more pleasant sensations (β = .21, p = .01). Exposure to maternal smoking was associated with less unpleasant sensations (β = −.20, p = .01). Adolescents carrying the G-variant of the OPRM1 A118G polymorphism were more likely to report liking (OR = 2.50, CI = 1.09–5.73) and adolescents homozygous for the C-variant of the DRD2 TaqlA polymorphism reported less unpleasant sensations (β = .18, p = .04). Conclusion: Although preliminary, these findings suggest that exposure to environmental smoking and polymorphisms in the OPRM1 and DRD2 gene may affect initial sensitivity to nicotine, an early phenotype of the risk of dependence. In the future, collaborative efforts to combine data from multiple studies in meta-analyses are needed to improve accuracy of estimated effects in genetic studies.

School-based promotion of cessation support: reach of proactive mailings and acceptability of treatment in smoking parents recruited into cessation support through primary schools.

BackgroundSeveral forms of cessation support have been shown effective in increasing the chance of successful smoking cessation, but cessation support is still underutilized among smokers. Proactive outreach to target audiences may increase use of cessation support.MethodsThe present study evaluated the efficiency of using study invitation letters distributed through primary schools in recruiting smoking parents into cessation support (quitline support or a self-help brochure). Use and evaluation of cessation support among smoking parents were examined.ResultsFindings indicate that recruitment of smokers into cessation support remains challenging. Once recruited, cessation support was well received by smoking parents. Of smokers allocated to quitline support, 88% accepted at least one counselling call. The average number of calls taken was high (5.7 out of 7 calls). Of smokers allocated to receive self-help material, 84% read at least some parts of the brochure. Of the intention-to-treat population, 81% and 69% were satisfied with quitline support or self-help material, respectively. Smoking parents were significantly more positive about quitline support compared to self-help material (p<.001).ConclusionsCessation support is well-received and well-used among smoking parents recruited through primary schools. Future studies need to examine factors that influence the response to offers of cessation support in samples of nonvolunteer smokers.Trial registrationThe protocol for this study is registered with the Netherlands Trial Register NTR2707

The relative role of nicotine dependence and smoking-related cognitions in adolescents’ process of smoking cessation

The present study evaluates the role of distinct components of nicotine dependence (craving, withdrawal, behavioural dependence) in comparison to smoking-related cognitions (attitudes, perceived social approval, self-efficacy) in adolescent smoking cessation. In the process towards smoking cessation, we distinguish between distinct behavioural transitions, respectively, short-term abstinence, reduction in smoking behaviour and prolonged cessation, to evaluate differences in cessation-related antecedents as a function of varying behavioural outcomes. A total of 850 adolescent smokers (age 14–16) participated in the present study. Smoking behaviour was assessed 1 year after baseline. Results showed that all dependence components had a distinct role in the prediction of behavioural change towards cessation. Furthermore, each behavioural transition was predicted by a distinct set of variables, indicating that contributions of cessation-related factors vary across the course towards cessation. Overall, our findings suggest that smoking-related cognitions are particularly relevant in the initiation of behavioural change, such as short-term abstinence, whereas nicotine dependence, craving in particular, becomes increasingly important in the prediction of maintained behavioural change, such as prolonged cessation. Implications encompass enhanced attention to the multidimensional nature of nicotine dependence and the value of comparing different behavioural outcomes in a comprehensive understanding of cessation-related factors.

Predictors of cessation treatment outcome and treatment moderators among smoking parents receiving quitline counselling or self-help material

OBJECTIVE Several cessation treatments effectively enhance cessation, but it is not always clear which treatment may be most suitable for a particular client. We examined predictors of treatment outcome and treatment moderators among smoking parents in the Netherlands. METHOD We conducted secondary analyses of a randomized controlled trial in which smoking parents received either quitline counselling (n=256) or a self-help brochure (n=256). Data collection was completed in October 2012. Endpoints were 7-day point prevalence abstinence and 6-month prolonged abstinence at 12-month follow-up. Potential predictors and moderators included socio-demographic characteristics, smoking-related variables, and child-related variables. RESULTS Male gender, higher employment status, lower daily cigarette consumption, higher levels of confidence in quitting, presence of a child with a chronic respiratory illness, and wanting to quit for the health of ones child predicted abstinence at 12months. Significant treatment moderators were intention to quit and educational level. Quitline counselling was effective regardless of intention to quit and educational level, but self-help material was less effective among less motivated and lower educated parents. CONCLUSION Certain subgroups of smokers, such as parents who are concerned about the health of their child, are particularly receptive to cessation support. Individual characteristics should be considered in treatment selections.

Promoting smoking cessation among parents: Effects on smoking-related cognitions and smoking initiation in children

BACKGROUND Parental smoking is associated with an increased risk of smoking among youth. Epidemiological research has shown that parental smoking cessation can attenuate this risk. This study examined whether telephone counselling for parents and subsequent parental smoking cessation affect smoking-related cognitions and smoking initiation among children of smoking parents. METHODS Data of a two-arm randomized controlled trial were used in which 512 smoking parents were recruited into cessation support through their childrens primary schools. After the baseline assessment, smoking parents were randomly assigned to tailored telephone counselling or a standard self-help brochure. Parental cessation was measured as 6-month prolonged abstinence at the 12-month follow-up. Childrens smoking-related cognitions and smoking initiation were examined at 3-month, 12-month, and 30-month follow-up. RESULTS No statistical evidence was found that children of parents who received telephone counselling tailored to smoking parents or children of parents who achieved prolonged abstinence differ in smoking-related cognitions (i.e., smoking outcome expectancies, perceived safety of smoking, self-efficacy to refrain from smoking, susceptibility to smoking) or smoking initiation rate on any follow-up assessment. CONCLUSIONS This study is the first to examine the effects of an evidence-based smoking cessation treatment for parents and treatment-induced parental smoking cessation on cognitive and behavioural outcomes among children. Although descriptive statistics showed lower smoking initiation rates among children of parents who achieved prolonged abstinence, there was no statistical evidence that telephone counselling tailored to parents or treatment-induced parental smoking cessation affects precursors of smoking or smoking initiation among youth.