Nicola Lindson-Hawley

Change in mental health after smoking cessation: systematic review and meta-analysis

Objective To investigate change in mental health after smoking cessation compared with continuing to smoke. Design Systematic review and meta-analysis of observational studies. Data sources Web of Science, Cochrane Central Register of Controlled Trials, Medline, Embase, and PsycINFO for relevant studies from inception to April 2012. Reference lists of included studies were hand searched, and authors were contacted when insufficient data were reported. Eligibility criteria for selecting studies Longitudinal studies of adults that assessed mental health before smoking cessation and at least six weeks after cessation or baseline in healthy and clinical populations. Results 26 studies that assessed mental health with questionnaires designed to measure anxiety, depression, mixed anxiety and depression, psychological quality of life, positive affect, and stress were included. Follow-up mental health scores were measured between seven weeks and nine years after baseline. Anxiety, depression, mixed anxiety and depression, and stress significantly decreased between baseline and follow-up in quitters compared with continuing smokers: the standardised mean differences (95% confidence intervals) were anxiety −0.37 (95% confidence interval −0.70 to −0.03); depression −0.25 (−0.37 to −0.12); mixed anxiety and depression −0.31 (−0.47 to −0.14); stress −0.27 (−0.40 to −0.13). Both psychological quality of life and positive affect significantly increased between baseline and follow-up in quitters compared with continuing smokers 0.22 (0.09 to 0.36) and 0.40 (0.09 to 0.71), respectively). There was no evidence that the effect size differed between the general population and populations with physical or psychiatric disorders. Conclusions Smoking cessation is associated with reduced depression, anxiety, and stress and improved positive mood and quality of life compared with continuing to smoke. The effect size seems as large for those with psychiatric disorders as those without. The effect sizes are equal or larger than those of antidepressant treatment for mood and anxiety disorders.

Does reduced smoking if you can’t stop make any difference?

BackgroundPromoting and supporting smoking reduction in smokers with no immediate intention of stopping smoking is controversial given existing fears that this will deter cessation and that reduction itself may not improve health outcomes.DiscussionEvidence shows that smokers who reduce the number of daily cigarettes smoked are more likely to attempt and actually achieve smoking cessation. Further, clinical trials have shown that nicotine replacement therapy benefits both reduction and cessation. Worldwide data suggests that ‘non-medical’ nicotine is more attractive to people who smoke, with electronic cigarettes now being widely used. Nevertheless, only one small trial has examined the use of electronic cigarettes to promote reduction, with direct evidence remaining inconclusive. It has been suggested that long-term reduced smoking may directly benefit health, although the benefits are small compared with cessation.SummaryThe combined data imply that smoking reduction is a promising intervention, particularly when supported by clean nicotine; however, the benefits are only observed when it leads to permanent cessation.

Gradual reduction vs abrupt cessation as a smoking cessation strategy in smokers who want to quit.

CLINICAL QUESTION Is gradual smoking cessation associated with poorer success rates than abrupt cessation in smokers who want to quit? BOTTOM LINE Gradual reduction may not be associated with a clinically significant difference in smoking cessation rates compared with abrupt cessation.

Should smokers be advised to cut down as well as quit

Paul Aveyard and Nicola Lindson-Hawley say that reducing smoking is a worthwhile step towards cessation, but Gerard Hastings and Marisa de Andrade argue that the lifelong nicotine replacement therapy being recommended in support may benefit industry more than public health

Future orientation and smoking cessation: secondary analysis of data from a smoking cessation trial

AIMS To examine the association between future orientation (how individuals consider and value outcomes in the future) and smoking cessation at 4 weeks and 6 months post quit-date in individuals enrolled in a smoking cessation study. DESIGN Cohort analysis of randomized controlled trial data. SETTING UK primary care. PARTICIPANTS Adults aged ≥18 years smoking ≥15 cigarettes daily, prepared to quit in the next 2 weeks. MEASUREMENTS Future orientation was measured prior to quitting and at 4 weeks post-quitting using the Consideration of Future Consequences Scale. Smoking cessation at 4 weeks and 6 months was confirmed biochemically. Those lost to follow-up were assumed to not be abstinent. Potential confounders adjusted for were: age, gender, educational attainment, nicotine dependence and longest previous period quit. FINDINGS A total of 697 participants provided data at baseline; 422 provided information on future orientation at 4 weeks. There was no evidence of an association between future orientation at baseline and abstinence at 4 weeks [adjusted odds ratio (aOR) = 1.05, 95% confidence intervals (CI) 0.80-1.38] or 6 months (aOR = 0.85, 95% CI = 0.60-1.20). There was no change in future orientation from baseline to 4 weeks and no evidence that the change differed between those who were and were not quit at 4 weeks (adjusted regression coefficient = -0.04, 95% CI = -0.16 to 0.08). CONCLUSIONS In smokers who are prepared to quit in the next 2 weeks, the extent of future orientation is unlikely to be a strong predictor of quitting over 4 weeks or 6 months and any increase in future orientation following quitting is likely to be small.

Does cigarette reduction while using nicotine replacement therapy prior to a quit attempt predict abstinence following quit date

Abstract Background and Aims Previous studies have reported that people who use a smoking cessation medication while smoking and reduce cigarette consumption spontaneously are three times more likely to stop smoking after a quit date. The aim was to replicate this and assess whether it arises because of willed effortful reduction rather than unwilled reduced drive to smoke caused by medication. Design Secondary analysis of a trial where participants were randomised to smoke as normal or reduce by 75% over 2 weeks prior to quit date, using nicotine replacement therapy (NRT) in both arms. Setting Thirty‐one UK primary care practices. Participants A total of 517 adult smokers seeking quitting support in the carbon monoxide (CO) analyses and 421 in the cigarettes/day analyses. Measurements Russell Standard abstinence was recorded 4 weeks after quit date. The randomized groups were combined and the association between reduction and abstinence examined. The second analysis assessed whether this association differed by whether smokers were, or were not, instructed to reduce. Findings In all participants, there was no evidence that reducing cigarettes/day or CO by at least half compared with not reducing predicted abstinence at 4 weeks [risk ratio (RR) = 0.88; 95% confidence interval (CI) = 0.68–1.14 and RR = 1.20; 95% CI = 1.00–1.44, respectively]. However, in smokers instructed to reduce, CO reduction was associated with 4‐week abstinence (RR = 1.52; 95% CI = 1.16–2.00), but not among people advised not to reduce (RR = 0.91; 95% CI = 0.67–1.24). Conclusions Smoking reduction prior to a target quit date while on a smoking cessation medication may only predict subsequent abstinence when smokers are consciously attempting to reduce.

Twenty years of the Cochrane Tobacco Addiction Group: Past, present, and future

Implications This review provides an overview of the work of Cochrane TAG. Readers will gain an insight into the origins of the group, its impact on evidence-based medicine relating to tobacco addiction, and the goals of the group moving forward. This supports the groups aim to encourage knowledge of Cochranes work within the field, and thereby the wider use of and contribution to high-quality systematic reviews and meta-analyses of the literature to improve policy and clinical practice.

Authors' reply to Sanderson and colleagues

Sanderson and colleagues wonder whether people try to quit smoking when mood improves and whether this could explain the association between quitting and improved mood in some of our cohorts.1 2 However, in more than half the studies, participants’ mood was assessed initially and then all attempted to quit immediately, so improved mood cannot have caused the decision to quit. Could a third factor explain both the success of quit attempts and improvements in mood? This factor, selectively associated with quitting, would have to …