Addressing Weight Gain in Smoking Cessation Treatment: A Randomized Controlled Trial
ABSTRACT Abstract Purpose . To evaluate the effectiveness of a cognitive behavioral treatment (CBT) addressing cessation-related weight concerns delivered via a tobacco quitline that does not address weight concerns. Design . Randomized controlled trial, blinded 6-month follow-up. Setting . The Oklahoma Tobacco Helpline (OKHL). Subjects . All 7998 smokers who called the OKHL were screened; 4240 were eligible; 2000 were randomized to the standard quitline (STD) or the brief version of the CBT weight concerns program (WCP). Intervention . Telephone counseling to help people quit smoking and address concerns about cessation-related weight gain. Measures . Demographics, weight, tobacco status, weight concerns, self-efficacy in quitting, and quitting without weight gain. Analysis . Descriptive statistics and logistic regression. Results . Of those randomized, 1002 participants completed the 6-month survey (response rates = 53.2% for STD, 47% for WCP). Compared with STD, WCP led to reduced weight concerns (p < .01) and less weight gain among quitters (1.8 vs. -3.4 pounds; p = .01). Although not significant, participants in the WCP were more likely to report 30-day abstinence (33.3% vs. 36.8%, p = .24; intent to treat = 17.7 vs. 17.3). Conclusion . The WCP was successfully delivered via a quitline and resulted in improved attitudes about weight and decreased cessation-related weight gain without harming quit rates. Promotion of a quitline focused on addressing weight in conjunction with quitline treatment for smoking cessation may improve cessation and weight outcomes. Study limitations include use of self-report and survey response.
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ABSTRACT: Weight gain that commonly accompanies smoking cessation can undermine a person's attempt to quit and increase the risk for metabolic disorders. Research indicates that obese smokers have more weight concerns and gain more weight after quitting than non-obese smokers, yet little is known about possible reasons for these outcomes. We sought to gain an understanding of obese smokers' experiences of quitting and their attitudes and beliefs about the association between smoking and weight gain. In-depth semi-structured interviews were conducted with obese smokers who called a state tobacco quitline. Interviewers elicited discussion of obese smokers' thoughts about smoking, the effects of quitting on change in weight, challenges they faced with quitting, and how quitlines might better serve their needs. Participants (n = 29) discussed their fear of gaining weight after quitting, their beliefs about smoking and their weight and significant experiences related to quitting. Participants' awareness of weight gain associated with quitting was based on prior experience or observation of others who quit. Most viewed cessation as their primary goal and discussed other challenges as being more important than their weight, such as managing stress or coping with a chronic health condition. Although weight gain was viewed as less important than quitting, many talked about changes they had made to mitigate the anticipated weight gain. Weight gain is a concern for obese smokers interested in quitting. Understanding the relative importance of body weight and other challenges related to smoking cessation can help tailor interventions for the specific group of smokers who are obese and interested in smoking cessation.BMC Public Health 11/2014; 14(1):1229. DOI:10.1186/1471-2458-14-1229 · 2.32 Impact Factor
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ABSTRACT: We conducted a pilot randomized trial of telephone-delivered acceptance and commitment therapy (ACT) versus cognitive behavioral therapy (CBT) for smoking cessation. Participants were 121 uninsured South Carolina State Quitline callers who were adult smokers (at least 10 cigarettes/day) and who wanted to quit within the next 30 days. Participants were randomized to 5 sessions of either ACT or CBT telephone counseling and were offered 2 weeks of nicotine replacement therapy (NRT). ACT participants completed more calls than CBT participants (M = 3.25 in ACT vs. 2.23 in CBT; p = .001). Regarding satisfaction, 100% of ACT participants reported their treatment was useful for quitting smoking (vs. 87% for CBT; p = .03), and 97% of ACT participants would recommend their treatment to a friend (vs. 83% for CBT; p = .06). On the primary outcome of intent-to-treat 30-day point prevalence abstinence at 6 months postrandomization, the quit rates were 31% in ACT versus 22% in CBT (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 0.7-3.4). Among participants depressed at baseline (n = 47), the quit rates were 33% in ACT versus 13% in CBT (OR = 1.2, 95% CI = 1.0-1.6). Consistent with ACT's theory, among participants scoring low on acceptance of cravings at baseline (n = 57), the quit rates were 37% in ACT versus 10% in CBT (OR = 5.3, 95% CI = 1.3-22.0). ACT is feasible to deliver by phone, is highly acceptable to quitline callers, and shows highly promising quit rates compared with standard CBT quitline counseling. As results were limited by the pilot design (e.g., small sample), a full-scale efficacy trial is now needed.Nicotine & Tobacco Research 06/2014; 16(11). DOI:10.1093/ntr/ntu102 · 2.81 Impact Factor
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ABSTRACT: Health interventions aimed at smoking cessation can clearly have a significant impact on public health around the globe. Even though the health benefits of quitting smoking are indisputable, research indicates that smoking cessation is associated with an increase in the prevalence of overweight. In this scenario, the present study evaluated the weight gain among patients participating in a smoking cessation intervention in order to find possible predictor variables.International journal of cardiology 01/2014; 172(2). DOI:10.1016/j.ijcard.2014.01.055 · 6.18 Impact Factor