The commitment to quitting smoking scale: initial validation in a smoking cessation trial for heavy social drinkers.

We tested the psychometric properties and predictive validity of a newly developed 8-item measure of commitment to quitting smoking, conceptualized as the state of being personally bound or obligated to persist in quitting smoking despite potential difficulties, craving and discomfort. Participants were 157 heavy drinking smokers enrolled in a clinical trial of smoking cessation treatments. The measure showed strong unidimensionality, good internal consistency, and moderate stability from baseline to quit date. Commitment significantly increased from baseline to quit date. Higher commitment to quitting at baseline predicted greater odds of abstinence at post-treatment and 16 and 26 weeks after quit date. Commitment predicted smoking outcome over and above level of tobacco dependence, self-reported importance of quitting smoking, and self-efficacy for remaining abstinent. Results suggest that commitment is a highly relevant construct for smoking cessation, which can be reliably assessed with the Commitment to Quitting Smoking Scale and which may be an excellent target for smoking cessation treatments.

Family factors are associated with psychological distress and smoking status in chronic obstructive pulmonary disease.

OBJECTIVE: The objective of this study was to test three hypotheses in a sample of individuals with chronic obstructive pulmonary disease (COPD): (1) unsupportive family relationships are associated with psychological distress, (2) psychological distress is associated with smoking status and (3) unsupportive family relationships are indirectly associated with smoking status via psychological distress. METHOD: Cross-sectional data were collected via self-report questionnaires completed by 455 individuals with COPD who had at least a 10-pack-year smoking history. The hypotheses were tested with structural equation modeling. RESULTS: All three hypotheses were supported. Unsupportive family relationships were associated with psychological distress (ß=.67, P<.001), psychological distress was associated with smoking status (ß=.40, P<.001), and unsupportive family relationships were indirectly associated with smoking status via psychological distress (ß=.27, P<.001). CONCLUSION: Results of this study suggest that family relationships are an important factor to include in future longitudinal research that attempts to elucidate social and psychological influences on smoking behavior.

Dimensions of depressive symptoms and smoking cessation.

Because different psychopathologic components of depressive symptoms may have distinct etiologies, examining their differential effects on smoking cessation may elucidate mechanisms underlying the smoking-depression relationship. Negative affect (NA), somatic features (SF), low positive affect/anhedonia (PA), and interpersonal disturbance (IP) have been identified as unique dimensions of depression that can be measured using the Center for Epidemiologic Studies Depression Scale (CESD). This study examined common and unique associations between CESD subscales and baseline smoking characteristics, nicotine withdrawal, and relapse in 157 participants enrolled in a smoking cessation trial for heavy social drinkers. Each dimension was univariately associated with negative and positive reinforcement smoking motives. Only SF had unique relations with tolerance smoking motives and univariate associations with nicotine dependence severity. Only PA predicted cessation-related changes in withdrawal symptoms on quit day. Analyses predicting abstinence at 8, 16, and 26 weeks post quit date showed that NA, SF, and PA each univariately predicted relapse, ps< or =.0083. Only low PA predicted poorer outcomes incrementally to the other dimensions, even when controlling for level of nicotine dependence, smoking frequency, and history of major depression, p = .0018. Interventions targeting anhedonia and low positive affect may be useful for smokers trying to quit.

Addressing heavy drinking in smoking cessation treatment: a randomized clinical trial.

Heavy alcohol use frequently co-occurs with cigarette smoking and may impede smoking cessation. This clinical trial examined whether smoking cessation treatment that incorporates brief alcohol intervention can improve smoking cessation outcomes (7-day verified point prevalence abstinence) and reduce drinks consumed per week. Heavy drinkers seeking smoking cessation treatment were assigned by urn randomization to receive, along with 8 weeks of nicotine replacement therapy, either a 4-session standard smoking cessation treatment (ST, n = 119) or standard treatment of equal intensity that incorporated brief alcohol intervention (ST-BI, n = 117). Across follow-ups over 26 weeks, participants in ST-BI reported approximately 20% fewer drinks per week (p < .027) and greater smoking abstinence (adjusted odds ratio = 1.56; 95% confidence interval = 1.01, 2.43) than did those in ST; however, effects on smoking were primarily evident at 2 weeks after quit date and were essentially absent by 16 weeks. The effect of ST-BI on smoking outcome was most robust among moderately heavy drinkers compared with that on very heavy drinkers. Integrating brief alcohol intervention into smoking cessation treatment appears feasible, but further development is needed to yield lasting effects on smoking.