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Abstract

Many smokers believe that smoking helps them to cope with stress, and that stopping smoking would deprive them of an effective stress management tool. Changes in stress levels following long-term smoking cessation are not well mapped. This longitudinal project was designed to provide more robust data on post-cessation changes in perceived stress levels by following a cohort of smokers admitted to hospital after myocardial infarction (MI) or for coronary artery bypass (CAB) surgery, as such patients typically achieve higher continuous abstinence rates than other comparable samples. A total of 469 smokers hospitalized after MI or CAB surgery and wanting to stop smoking were seen in the hospital and completed 1-year follow-ups. Ratings of helpfulness of smoking in managing stress at baseline, smoking status (validated by salivary cotinine concentration) and ratings of perceived stress at baseline and at 1-year follow-up were collected. Of the patients, 41% (n = 194) maintained abstinence for 1 year. Future abstainers and future smokers did not differ in baseline stress levels or in their perception of coping properties of smoking. However, abstainers recorded a significantly larger decrease in perceived stress than continuing smokers, and the result held when possible confounding factors were controlled for (P < 0.001). In highly dependent smokers who report that smoking helps them cope with stress, smoking cessation is associated with lowering of stress. Whatever immediate effects smoking may have on perceived stress, overall it may generate or aggravate negative emotional states. The results provide reassurance to smokers worried that stopping smoking may deprive them of a valuable coping resource.

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... Individuals with depressive tendencies are, in fact, twice as likely to be smokers (often heavy smokers) (2,3). The majority (85%) of smokers believe that smoking relieves stress (4). However, smokers feel calm simply because the symptoms of their nicotine withdrawal have temporarily abated (5). ...
... Quitting smoking is known to improve the quality of life and support positive emotions while reducing depression, anxiety, and stress (4,5,9). Quitting smoking can also reduce the risk of developing depressive symptoms to the same level found in non-smokers (10). ...
... Quitting smoking can also reduce the risk of developing depressive symptoms to the same level found in non-smokers (10). Most of the studies regarding the effects of quitting smoking on depression have examined an improvement over a relatively extended period of several months to several years (4,5). When mentally unstable patients with depression quit smoking, their depression is known to temporarily worsen soon after quitting, regardless of the type of nicotine replacement used (a nicotine patch or varenicline (11) ). ...
Article
Objective The psychological status is a key factor in smoking continuance. However, details on short-term changes in mild depressive states after smoking cessation (SC) are still unknown. The purpose of the present study was to investigate these short-term changes. Methods A total of 989 patients who visited our SC Clinic were assessed using the Zung Self-Rating-Depression-Scale (SDS), an official instrument to measure depressive tendencies. The participants were classified into normal and neurotic groups based on their SDS scores during their initial visit; they were assessed again 2, 4, 8, and 12 weeks thereafter. Results The majority of patients in the neurotic group were women. These patients were also younger, with a higher nicotine dependence, and presented with a lower successful SC rate than the patients in the normal group. A decrease in SDS scores after starting the SC treatment was observed only in the neurotic group, especially during the first two weeks. In patients who continued to smoke, no improvement in depressive tendencies was noted in this period. Conclusion Depressive tendencies of patients with neurosis improve in the initial stages of the SC treatment (i.e. within two weeks after starting the treatment). This finding fills the mentioned knowledge gap regarding the effects of SC on mild depressive states in the short term.
... Additionally, neighbourhood deprivation is an independent source of stress, over and above individual SES and other factors [17]. Stress is associated with health-risk behaviour [19][20][21][22][23][24][25][26][27], possibly in large part because people often cope with feelings of stress through risky, but often pleasurable, behaviours [10,20,21,[28][29][30][31][32][33] such as eating high-fat foods, smoking, and drinking alcohol [10]. Furthermore, the motivation for physical activity may be limited when experiencing stress [10]. ...
... In the research on the association between stress and health-risk behaviour, there is often the perception that health-risk behaviour can be a tool to cope with stress [10,20,21,[28][29][30][31][32][33] because behaviours such as smoking and eating high-fat food give immediate pleasure [20,33]. However, research cannot establish with certainty that health-risk behaviours are used as coping tools for stress [30]. ...
... In the research on the association between stress and health-risk behaviour, there is often the perception that health-risk behaviour can be a tool to cope with stress [10,20,21,[28][29][30][31][32][33] because behaviours such as smoking and eating high-fat food give immediate pleasure [20,33]. However, research cannot establish with certainty that health-risk behaviours are used as coping tools for stress [30]. ...
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Background Previous studies have found that residents of deprived neighbourhoods have an increased risk of perceived stress compared to residents with similar sociodemographic and socioeconomic characteristics in non-deprived neighbourhoods. While stress may provide an explanatory pathway linking neighbourhood deprivation to health-risk behaviour, only limited research has been undertaken on whether perceived stress influences health-risk behaviour in deprived neighbourhoods. Moreover, it is uncertain whether perceived stress has a negative effect on the associations between socioeconomic status and health-risk behaviours in deprived neighbourhoods. The overall aim of this study was to compare perceived stress in deprived neighbourhood with that in the general population, and to examine whether perceived stress was associated with health-risk behaviours (including their co-occurrence) in deprived neighbourhoods. A further aim was to examine whether perceived stress modified the associations between socioeconomic status and health-risk behaviours. Methods Four questions from the Perceived Stress Scale were used as indicators of perceived stress. Multiple logistic regression analyses were applied to cross-sectional data from 5113 adults living in 12 deprived neighbourhoods in Denmark. Data from 14,868 individuals from the nationally representative Danish Health and Morbidity Survey 2010 were used as a comparison group with regard to perceived stress. ResultsResidents of deprived neighbourhoods had higher odds of perceived stress than the general population. Associations between disposable income, economic deprivation, strain, and perceived stress were found in deprived neighbourhoods. Perceived stress was significantly associated with higher odds of health-risk behaviour, including a low intake of fruit or vegetables, daily smoking, physical inactivity, and the co-occurrence of health-risk behaviours, even after adjustment for demographic and socioeconomic characteristics. Perceived stress was more strongly associated with physical inactivity and having two or more health-risk behaviours among residents with medium/high socioeconomic status compared to residents with low socioeconomic status. Conclusions Overall, the study showed a clear association between perceived stress and health-risk behaviour in deprived neighbourhoods. Future health promotion interventions targeting deprived neighbourhoods may benefit from incorporating stress reduction strategies to reduce health-risk behaviour. Further research is needed to fully understand the mechanism underlying the association between perceived stress and health-risk behaviour in deprived neighbourhoods.
... Psychological distress is also associated with a lower probability of smoking cessation and high levels of nicotine dependence, thus increasing the risk of relapse during the first year of follow-up. (24)(25)(26) Some of the studies evaluated showed that smokers and former smokers have depressive symptoms more often than do nonsmokers, and that smokers who use antidepressants are more likely to suffer from anxiety and insomnia. (27)(28)(29) The data also suggest that smoking cessation is associated with reduced anxiety and distress. ...
... Year Journal Country of origin N Type of study Figueiró et al. (11) 2013 Trends Psychiatry Psychother Brazil 54 Cohort Castro et al. (18) 2010 J Bras Pneumol Brazil 167 Cross-sectional Lawrence et al. (24) 2011 BMC Public Health USA 31,428 Cross-sectional Cosci et al. (25) 2009 Addict Behav Italy 297 Double-blind, randomized Hajek et al. (26) 2010 Addiction England 469 Randomized clinical trial Pfaff et al. (27) 2009 Can J Cardiovasc Nurs Canada 57 Cross-sectional Gravely-Witte et al. (28) (31) 2009 Rev Port Pneumol Brazil 567 Retrospective analysis Greenwood et al. (32) 1995 J Epidemiol Community Health UK 1,283 Cross-sectional Sachs-Ericsson et al. (33) 2009 ...
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Among all causes of preventable deaths, smoking is responsible for the greatest number of deaths worldwide and predisposes to fatal, noncommunicable diseases, especially cardiovascular diseases. Lifestyle changes are effective in the treatment of patients with smoking-related diseases and assist in the prevention of premature mortality. Our objective was to investigate the available scientific evidence regarding the psychological distress related to smoking cessation in patients who have had acute myocardial infarction. To that end, we conducted an integrative review of the literature in order to summarize relevant studies on this topic. The selected databases were Scopus, PubMed Central, Institute for Scientific Information Web of Science (Core Collection), ScienceDirect, EMBASE, SciELO, LILACS e PsycINFO. On the basis of the inclusion and exclusion criteria adopted for this study, 14 articles were selected for analysis. Those studies showed that the prevalence of psychological distress is higher among smokers than among nonsmokers, and distress-related symptoms are much more common in smokers with acute myocardial infarction than in those without. Smoking cessation depends on the active participation of the smoker, whose major motivation is the underlying disease. Most studies have shown that there is a need to create treatment subgroups as a means of improving the treatment provided. This review article expands the knowledge regarding smoking cessation and shows the need to invest in future research that investigates subgroups of smokers diagnosed with the major smoking-related comorbidities, such as acute myocardial infarction, in order to develop specific interventions and psychological support strategies.
... We were unable to identify literature on stress as a predictor of smoking cessation, despite stress being listed as a perceived barrier to cessation by cancer patients (McBride and Ostroff, 2003;Ark et al., 1997;Wells et al., 2017). Similarly, while in the general population, smoking cessation has been correlated with corresponding reductions in perceived stress and distress (Cohen and Lichtenstein, 1990;Hajek et al., 2010;McDermott et al., 2013;Parrott, 1995), to our knowledge, no prior work has investigated this relationship in cancer patients. Thus, it remains unknown whether a smoking cessation intervention tailored to the psychological needs of cancer patients can effectively reduce stress and psychological distress and whether, correspondingly, improvements in these outcomes may positively influence smoking cessation outcomes. ...
... Consistent with smoking cessation research in the general population, (Cohen and Lichtenstein, 1990;Hajek et al., 2010;McDermott et al., 2013;Parrott, 1995) we found that patients attempting to quit smoking reported decreases in stress and distress across the study, with the lowest symptoms generally reported by those who had quit by 3 months and stayed quit at 6 months. We extend these findings specifically to patients newly diagnosed with cancer. ...
Article
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Introduction Cancer patients who smoke report more stress and psychological distress than patients who do not smoke. It is unclear how these emotional symptoms may modify smoking behavior in cancer patients. We examined the influence of a smoking cessation intervention for cancer patients on stress and distress, and the effects of these symptoms on smoking abstinence. Methods Mixed-methods secondary analysis of data from the Smokefree Support Study, a two-site randomized controlled trial examining the efficacy of Intensive (IT; n=153) vs. Standard Treatment (ST; n=150) for smoking cessation in newly diagnosed cancer patients. Stress coping, perceived stress, distress, and anxiety were self-reported at baseline, 3, and 6 months. Abstinence was biochemically-confirmed at 6 months. A subset of patients (n=72) completed qualitative exit-interviews. Results Patients were on average, 58 years old, 56% female, and smoked a median of 10 cigarettes/day. There were no significant treatment group x time interactions or main effects of treatment group on stress or distress measures (p’s>.05), however there were significant main effects of time suggesting symptom improvements on each measure in both study groups (p’s<.05). In adjusted logistic regression models, lower levels anxiety at 3 months predicted confirmed smoking abstinence at 6 months (p=.03). Qualitatively, at 6 months, patients reported their stress and smoking were connected and that the cessation counseling was helpful. Conclusions Cancer patients enrolled in a smoking cessation trial report decreases in stress, distress and anxiety over time, and anxiety symptoms may impact smoking cessation success at follow-up resulting in an important intervention target.
... Therefore health promotion messages that combat these misperceptions regarding the happiness benefits of smoking by countering that quitting smoking is associated with increased happiness may serve to increase parents' motivation to remain quit. A number of studies have demonstrated that people experience decreased anxiety after quitting smoking (Cohen & Lichtenstein, 1990;Hajek, Taylor, & McRobbie, 2010;McDermott, Marteau, Hollands, Hankins, & Aveyard, 2013;West & Hajek, 1997). Even among individuals with depression, research has shown that cessation does not increase the likelihood of exacerbating depression (Shahab et al., 2014;Shahab, Andrews, & West, 2013). ...
... There is some evidence that those who try to quit and are unsuccessful may experience an increase in anxiety, though research does not support the widely held belief that smoking is effective at reducing stress (McDermott et al., 2013). Instead successful smoking cessation has been shown to be associated with mental health benefits in this study and others (Cohen & Lichtenstein, 1990;Hajek, et al., 2010;Shahab & West, 2009). Educating both smokers and health care providers about the mental health benefits of quitting could encourage cognitive reframing away from exaggerated negative expectancies of quitting toward a more hopeful outlook for both smokers and health care providers. ...
Article
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Introduction: Smoking cessation among adults is associated with increased happiness. This association has not been measured in parents, a subset of adults who face uniquely stressful and challenging circumstances that can affect happiness. Aims: The aim of this study was to determine if parental smoking cessation is associated with increased happiness and to identify characteristics of parental quitters who experience increased happiness. Methods: A total of 1,355 parents completed a 12-month follow-up interview from a U.S. national trial, Clinical Effort Against Secondhand Smoke Exposure (CEASE). Multivariable logistic regression examined if level of happiness was independently associated with quitting smoking and identified characteristics associated with feeling happier after quitting smoking. Results/Findings: Parents’ level of happiness was independently associated with quitting smoking (aOR = 1.60, 95% CI = 1.42–1.79). Factors associated with increased happiness among quitters include engaging in evidence-based cessation assistance (aOR = 2.69, 95% CI = 1.16–6.26), and adopting strictly enforced smoke-free home (aOR = 2.55, 95% CI = 1.19–5.48) and car (aOR = 3.85, 95% CI = 1.94–7.63) policies. Additionally, parents who believed that being a smoker got in the way of being a parent (aOR = 5.37, 95% CI = 2.61–11.07) and who believed that thirdhand smoke is harmful to children (aOR = 3.28, 95% CI = 1.16–9.28) were more likely to report feeling happier after quitting. Conclusions: Parents who quit smoking reported being happier than parents who did not quit. Though prospective studies can clarify what factors cause an increase in happiness, letting paediatricians know that most parents who smoke report being happier when quitting may facilitate communication with parents around cessation.
... The theory is that alveolar macrophages are activated when smoke enters the lungs, leading to elevated levels of peptidyl arginine deaminase expression in the lungs, which is involved in the formation of citrulinated peptides [82]. Perceived stress has been shown to influence one's susceptibility to both start the habit of smoking cigarettes and to quit [83][84][85][86]. In a large prospective study on people who sought to quit smoking, researchers wanted to know how stress both predicts successful smoking cessation and is influenced by quitting. ...
Article
Stress is defined as the pscyophysiological reaction in which the steady state is disturbed or threatened. Stress is not always perceived as a negative response. Stress results when environmental demands exceed an individuals' adaptive capacities. Autoimmune diseases are heterogeneous group of chronic diseases which occur secondary to loss of self antigen tolerance. The etiopathogenesis of autoimmune disease is uncertain. Genetic factors as well as environmental factors appear to interplay, leading to a cascade of events resulting in disease onset. Stress has been postulated to play a role in disease onset in the genetically susceptible patients. During the stress response, catecholamines and glucocorticoids are released from locus coeruleus and adrenal gland. These biomolecules exert control over various immune cells in the innate and adaptive arms of the immune system, thereby altering the cytokine profile released. The increase of IL-4 promotes T-helper 2 (Th2) cell differentiation, while the decrease in IL-12 and the increased IL-10 production reduce the number of T-helper 1 (Th1) cells.. The relationship between stress and autoimmune diseases is intricate. Stress has been shown to be associated with disease onset, and disease exacerbations in rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease, multiple sclerosis, Graves' disease as well as other autoimmune conditions. In certain conditions such as psoriasis, stress has been implicated in delaying lesion clearance upon the application of standard treatment regimes. Finally, psychological therapy and cognitive behavioral therapy aimed to reduce stress levels was shown to be effective in influencing better outcomes in many autoimmune diseases. The purpose of this paper is to closer inspect the clinical evidence regarding the role of stress on influencing the various aspects of disease entities.
... Smoking is a behavior that is reported to relieve stress [23][24][25][26]. However, the stress hormone, cortisol, is shown to be elevated in smokers compared to non-smokers [27], and perceived stress levels reduce after smokers quit [28]. The elevation of cortisol in smokers is attributed to nicotine exposure [29,30]. ...
Article
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BACKGROUND: The Family Smoking Prevention and Tobacco Control Act gave the Food and Drug Administration jurisdiction over the regulation of all tobacco products, including their nicotine content. Under this act, a major strategy to reduce harm from cigarette tobacco is lowering the nicotine content without causing unintended adverse consequences. Initial research on reduced nicotine content (RNC) cigarettes has shown that smokers of these cigarettes gradually decrease their smoking frequency and biomarkers of exposure. The effectiveness of this strategy needs to be demonstrated in different populations whose response to RNC cigarettes might be substantially mediated by personal or environmental factors, such as low socioeconomic status (SES) populations. This study aims to evaluate the response to a reduced nicotine intervention in low SES smokers, as defined here as those with less than 16 years of education, by switching smokers from high nicotine commercial cigarettes to RNC cigarettes. METHODS/DESIGN: Adults (N = 280) who have smoked five cigarettes or more per day for the past year, have not made a quit attempt in the prior month, are not planning to quit, and have less than 16 years of education are recruited into a two-arm, double-blinded randomized controlled trial. First, participants smoke their usual brand of cigarettes for 1 week and SPECTRUM research cigarettes containing a usual amount of nicotine for 2 weeks. During the experimental phase, participants are randomized to continue smoking SPECTRUM research cigarettes that contain either (1) usual nicotine content (UNC) (11.6 mg/cigarette) or (2) RNC (11.6 to 0.2 mg/cigarette) over 18 weeks. During the final phase of the study, all participants are offered the choice to quit smoking with nicotine replacement therapy, continue smoking the research cigarettes, or return to their usual brand of cigarettes. The primary outcomes of the study include retention rates and compliance with using only research cigarettes and no use of other nicotine-containing products. Secondary outcomes are tobacco smoke biomarkers, nicotine dependence measures, smoking topography, stress levels, and adverse health consequences. DISCUSSION: Results from this study will provide information on whether low SES smokers can maintain a course of progressive nicotine reduction without increases in incidence of adverse effects.
... Smokers may be smoking to relieve psychological stress. However, several studies showed that although smoking could temporarily relieve perceived psychological stress, it may also aggravate negative emotional states, which may lead to overall higher psychological stress levels (Hajek, Taylor, & McRobbie, 2010;Parrott, 1995;Stein et al., 2008). Chronic smoking may also fuel negative coping strategies, for example, the management of psychologically stressful events, and act as a moderator of the impact of psychological stress on health (Baum & Posluszny, 1999). ...
Article
The direction and magnitude of the associations between cardiovascular risk factors (CVRFs) and psychological stress continue to be debated, and no data are available from surveys in the African region. In this study, we examine the associations between CVRFs and psychological stress in the Seychelles, a rapidly developing small island state in the African region. A survey was conducted in 1,240 adults aged 25-64 years representative of the Seychelles. Participants were asked to rank psychological stress that they had experienced during the past 12 months in four domains: work, social life, financial situation, and environment around home. CVRFs (high blood pressure, tobacco use, alcohol drinking, and obesity) were assessed using standard procedures. Psychological stress was associated with age, sex, and socioeconomic status. Overall, there were only few consistent associations between psychological stress and CVRFs, adjusting for age, sex, and socioeconomic status. Social stress was associated with smoking, drinking, and obesity, and there were marginal associations between stress at work and drinking, and between financial stress, and smoking and drinking. Psychological stress was not associated with high blood pressure. These findings suggest that psychological stress should be considered in cardiovascular disease prevention and control strategies.
... In addition to treatments, other management strategies can also play a role in the reduction of symptoms for mood and anxiety disorders, by changing the lifestyle of those affected. Exercising [11][12][13] and smoking cessation [14][15][16] are both effective adjunctive interventions. Alcohol problems are associated, probably causally, with mood or anxiety disorders [17,18]; a reduction of use is required by many medications [19], and increased use can lead to a worsening of symptoms [20]. ...
Article
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Background The exact nature of treatment and management recommendations made, and received, for mood and anxiety disorders in a community population is unclear. In addition, there is limited evidence on the impact of recommendations on actual receipt of treatment or implementation of management strategies. We aim to describe the frequency with which specific recommendations were made and implemented; and thus assess the size of any gap between the recommendation and implementation of treatments and management strategies. Methods We used the Survey ‘Living with a Chronic Condition in Canada - Mood and Anxiety Disorders (SLCDC-MA), a unique crossectional survey of a large (N = 3358) and representative sample of Canadians with a diagnosed mood or anxiety disorder, which was conducted by Statistics Canada. The survey collected information on recommendations for medication, counselling, exercise, reduction of alcohol consumption, smoking cessation and reduction of street drug use. We also estimate the frequency that recommendations are made and followed, as well the impact of the prior on the latter. We consulted people with lived experience of the disorders to help interpret our results. ResultsThe results generally showed that most people would receive recommendations, almost all for antidepressant medications (94.6%), with lower proportions for the other treatment and management strategies (e.g. 62.1 and 66% for counselling and exercise). Most recommendations were implemented and had an impact on behaviour. The exception to this was smoking reduction/cessation, which was often not recommended or followed through. Other than with medication, at least 20% of the population, for each recommendation, would not have their recommendation implemented. A substantive group also exists who access treatments, and employ various management strategies, without a recommendation. Conclusions The results indicate that there is a gap between recommendations made and the implementation of treatments. However, its size varies substantially across treatments.
... Akre and colleagues cite difficulties in quitting tobacco and cannabis simultaneously [10], due to cannabis withdrawal raising perceived stress levels and smoking tobacco a perceived source of relief from stress. However there is a body of research showing that tobacco cessation, in fact, leads to significant reductions in perceived stress [18,19], at least in people who manage to maintain smoking abstinence over an extended period of time, suggesting a greater need for professional understanding and client assurance at intervention stage. ...
Article
We report the case of a heavy cannabis and tobacco user tracked over a fifteen-week treatment episode comprising tobacco and cannabis cessation interventions, with successive follow-ups at three, six and nine months. Upon treatment exit, the client was abstinent from both cannabis and tobacco, sustained at three-month followup. At six months, the client had returned to smoking tobacco but maintained abstinence from cannabis. At final follow-up the client reported several lapses of cannabis use alongside continued tobacco smoking. The case suggests that, for some clients at least, over the initial withdrawal period abstinence from one substance does not undermine abstinence from another. It also suggests that clients accessing community drug treatment may benefit from concurrent smoking cessation interventions, and that addressing stress may be key to sustaining positive treatment outcomes.
... (37,38) However, paradoxically, there are reports that former smokers exhibit fewer symptoms of anxiety, depression, and lower stress levels compared to baseline measurements. (39,40) On the other hand, it is common for women to represent cigarette smoking as an effective way to deal with negative states. Moreover, pregnancy involves increases of anxious and depressed states due to hormonal changes, as well as it represents a phase which carries a higher overall stress load. ...
Article
Objective: To investigate how social and psychological characteristics differ between pregnant women who smoke and do not smoke. To explore associations between social and psychological features with changes of smoking habits by the end of pregnancy. Methods: A case-control study was set up. Smokers cases were never-smokers and ex-smokers controls. Pregnant women (n=328) from public prenatal services were interviewed. Socio-demographic data and psychological variables - personality traits, anxiety, depression, perceived stress, maternal fetal-attachment - were measured. Saliva samples were collected to measure cotinine and to check self-informed smoking status. In addition, 66 smokers were also assessed regarding smoking habits by late pregnancy. Smoking status was defined as a dependent variable. Exposure factors were analyzed through odds ratios. Logistic models and contingency tables were employed according to the nature of variables. "Qualitative change in smoking" was defined as a dependent variable for the last evaluation, and a logistic regression model was built. Results: Lower schooling, higher age, use of alcohol and drugs, living without a partner, and passive smoking showed associations with smoking. Anxiety, depression and perceived stress also exhibited positive association with smoking. Among personality traits, only Neuroticism was associated with smoking. None of the variables were associated with qualitative change in smoking by the end of pregnancy. Conclusion: Smoking during pregnancy is associated with more unfavorable social conditions. Pregnant women who smoke exhibit more negative psychological states than nonsmokers, including a profile of accentuated Neuroticism. None of the investigated variables could predict changes in smoking during pregnancy.
... * Lifestyle variables concur to define stress levels and by modifying individuals' habits may contribute to improve individuals' wellness. Among these variables, that are all selfreported, it is possible to mention, for example, the circumstance to be a smoker (Hajek, Taylor, & McRobbie, 2010); the addiction to alcohol (Babor, Higgins-Biddle, Saunders, & Monteiro, 2001;Ginn, Helms, Morgan, & Pegram, 2004;Mensch & Kandel, 1988), that is proxied by the alcohol use disorders identification test (AUDIT) scores (Saunders, Aasland, Babor, de la Fuente, & Grant, 1993); the frequency of physical activity (Coulter, Dickman, & Maradiegue, 2009;Cowley, Kiely, & Collins, 2017); the sleep pattern (Han, Kim, & Shim, 2012;Partinen, 1994) that is measured through the number of hours slept per night and through a dummy variable indicating those individuals whose reported sleeping time <5 hours per night: and the circumstance to have experienced depression, although it is not clinically diagnosed but self-reported. Table 1 lists all the variables employed in the empirical analysis together with their definition. ...
... It is possible that those who believe that smoking helps to manage mood may be more likely to relapse when early depressive symptoms occur during a quit attempt. However, two studies have found that smokers who believe cigarettes help manage stress actually reported lower stress levels after quitting ( [10,11]. ...
Article
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Aims: To determine whether abstinence or relapse on a quit attempt in the previous year is associated with current depressive symptoms. Design: Prospective cohort with approximately annual waves. Mixed-effect logistic regressions tested whether time 2 (T2) quitting status was associated with reporting symptoms at T2, and whether time 1 (T1) symptoms moderated this relationship. Setting: Waves 5-8 of the Four-Country International Tobacco Control Study: a quasi-experimental cohort study of smokers from Canada, the United States, the United Kingdom and Australia. Participants: A total of 6978 smokers who participated in telephone surveys. Measurements: T1 and T2 depressive symptoms in the last 4 weeks were assessed with two screening items from the PRIME-MD questionnaire. Quitting status at T2: (1) no attempt since T1; (2) attempted and relapsed; and (3) attempted and abstinent at T2. Findings: Compared with no attempt, relapse was associated with reporting T2 symptoms [odds ratio (OR) = 1.46, 95% confidence interval (CI) = 1.33, 1.59]). Associations between T2 quitting status and T2 symptoms were moderated by T1 symptoms. Relapse was associated positively with T2 symptoms for those without T1 symptoms (OR = 1.71, 95% CI = 1.45, 2.03) and those with T1 symptoms (OR = 1.45, 95% CI = 1.23, 1.70). Abstinence was associated positively for those without T1 symptoms (OR = 1.37, 95% CI = 1.10, 1.71) and negatively for those with T1 symptoms (OR = 0.74, 95% CI = 0.59, 0.94). Age moderated these associations significantly. Relapse did not predict T2 symptoms for those aged 18-39 irrespective of T1 symptoms. The negative effect of abstinence on T2 symptoms for those with T1 symptoms was significant only for those aged 18-39 (OR = 0.61, 95% CI = 0.40, 0.94) and 40-55 (OR = 0.58, 95% CI = 0.40, 0.84). The positive effect of abstinence on T2 symptoms for those without T1 symptoms was significant only for those aged more than 55 (OR =1.97, 95% CI = 1.35, 2.87). Conclusions: Most people who stop smoking appear to be at no greater risk of developing symptoms of depression than if they had continued smoking. However, people aged more than 55 who stop smoking may be at greater risk of developing symptoms of depression than if they had continued smoking.
... 103 However, despite smokers stating that they smoke to cope with stress, higher levels of stress have been found among smokers, 104 which then declines with smoking cessation. 105 Thus, smoking tobacco (rather than stopping) appears to be associated with heightened feelings of stress. This is an important message for services to communicate to clients. ...
Article
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Background: NHS Stop Smoking Services (SSSs) provide free at the point of use treatment for smokers who would like to stop. Since their inception in 1999 they have evolved to offer a variety of support options. Given the changes that have happened in the provision of services and the ongoing need for evidence on effectiveness, the Evaluating Long-term Outcomes for NHS Stop Smoking Services (ELONS) study was commissioned. Objectives: The main aim of the study was to explore the factors that determine longer-term abstinence from smoking following intervention by SSSs. There were also a number of additional objectives. Design: The ELONS study was an observational study with two main stages: secondary analysis of routine data collected by SSSs and a prospective cohort study of service clients. The prospective study had additional elements on client satisfaction, well-being and longer-term nicotine replacement therapy (NRT) use. Setting: The setting for the study was SSSs in England. For the secondary analysis, routine data from 49 services were obtained. For the prospective study and its added elements, nine services were involved. The target population was clients of these services. Participants: There were 202,804 cases included in secondary analysis and 3075 in the prospective study. Interventions: A combination of behavioural support and stop smoking medication delivered by SSS practitioners. Main outcome measures: Abstinence from smoking at 4 and 52 weeks after setting a quit date, validated by a carbon monoxide (CO) breath test. Results: Just over 4 in 10 smokers (41%) recruited to the prospective study were biochemically validated as abstinent from smoking at 4 weeks (which was broadly comparable with findings from the secondary analysis of routine service data, where self-reported 4-week quit rates were 48%, falling to 34% when biochemical validation had occurred). At the 1-year follow-up, 8% of prospective study clients were CO validated as abstinent from smoking. Clients who received specialist one-to-one behavioural support were twice as likely to have remained abstinent than those who were seen by a general practitioner (GP) practice and pharmacy providers [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.2 to 4.6]. Clients who received group behavioural support (either closed or rolling groups) were three times more likely to stop smoking than those who were seen by a GP practice or pharmacy providers (OR 3.4, 95% CI 1.7 to 6.7). Satisfaction with services was high and well-being at baseline was found to be a predictor of abstinence from smoking at longer-term follow-up. Continued use of NRT at 1 year was rare, but no evidence of harm from longer-term use was identified from the data collected. Conclusions: Stop Smoking Services in England are effective in helping smokers to move away from tobacco use. Using the 52-week CO-validated quit rate of 8% found in this study, we estimate that in the year 2012-13 the services supported 36,249 clients to become non-smokers for the remainder of their lives. This is a substantial figure and provides one indicator of the ongoing value of the treatment that the services provide. The study raises a number of issues for future research including (1) examining the role of electronic cigarettes (e-cigarettes) in smoking cessation for service clients [this study did not look at e-cigarette use (except briefly in the longer-term NRT study) but this is a priority for future studies]; (2) more detailed comparisons of rolling groups with other forms of behavioural support; (3) further exploration of the role of practitioner knowledge, skills and use of effective behaviour change techniques in supporting service clients to stop smoking; (4) surveillance of the impact of structural and funding changes on the future development and sustainability of SSSs; and (5) more detailed analysis of well-being over time between those who successfully stop smoking and those who relapse. Further research on longer-term use of non-combustible nicotine products that measures a wider array of biomarkers of smoking-related harm such as lung function tests or carcinogen metabolites. Funding: The National Institute for Health Research Health Technology Assessment programme. The UK Centre for Tobacco and Alcohol Studies provided funding for the longer-term NRT study.
... Among smokers hospitalized for AMI or coronary artery bypass grafting, followed for one year after discharge, smoking cessation was significantly associated with the largest decrease in perceived stress. These findings support a hypothesis that smoking would not help relieve stress, as believed by some smokers, but could act as a stressor, for example, due to breaks between cigarettes (30) . ...
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Objective: to assess whether dietary intake of patients with acute coronary syndrome (ACS) meets national and international recommendations and whether there is a relationship with the levels of stress. Method: a cross-sectional study with 150 patients with ACS, who were interviewed with the Food Frequency Questionnaire and the Perceived Stress Scale-10. Results: daily intake above the recommendations: cholesterol (92%), fiber (42.7%) and protein (68%); intake below the recommendations: potassium (88%) and carbohydrates (68.7%); intake according to the recommendations: sodium (53.3%) and lipids (53.3%). Most patients with inadequate dietary intake (54%) were stressed or highly stressed. There was a signifi cant association between a lower stress level and a higher fi ber intake. Conclusion: in patients with ACS, dietary intake did not meet the guideline recommendations, and a lower fi ber intake occurs concomitantly with higher stress levels. Educational efforts can support patients in dietary intake adequacy and stress control.
... A common belief is that smoking helps in coping with stress but the little evidences available on the theme challenge this assumption. Researchers related smoking cessation of highly dependent smokers to lowering of stress [3]. Never smokers seem to be happier than current smokers and, after stopping smoking for one year or e 1 1 1 6 0 -1 SMOKE AND THRIVING: AN ECOLOGICAL STUDY more, ex-smokers increase their happiness level above the current smokers' level [4]. ...
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Studies suggest a possible inverse correlation between smoking attitude and happiness levels. The present paper investigates the relation between males and females smoking prevalence and happiness levels in 155 countries worldwide. Analyses, after adjusting for socioeconomic factors, reveal a different relationship between happiness and prevalence of tobacco smoking in the two genders. Countries with highest prevalence of males smoking show the lowest wellbeing levels (Beta coefficient:-0.350; P Value <0.001) while countries with highest prevalence of females smoking show the highest levels of wellbeing (Beta coefficient: 0.144; P Value: 0.030). The countries with the highest prevalence of people thriving are those with the highest prevalence of women smoking and the lowest prevalence of males smoking.
... Smokers typically demonstrate higher levels of stress and low mood than non-smokers and ex-smokers. [115][116][117] Smoking may provide a coping mechanism for individuals who are prone to higher levels of stress [118][119][120] or smoking may act as a stressor due to neurobiological processes or through the experience of withdrawal symptoms. 120 Stressors associated with vulnerable groups (eg, unemployment, financial stress and poverty) may compound stress levels within vulnerable groups. ...
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To identify barriers that are common and unique to six selected vulnerable groups: low socioeconomic status; Indigenous; mental illness and substance abuse; homeless; prisoners; and at-risk youth. A systematic review was carried out to identify the perceived barriers to smoking cessation within six vulnerable groups. MEDLINE, EMBASE, CINAHL and PsycInfo were searched using keywords and MeSH terms from each database's inception published prior to March 2014. Studies that provided either qualitative or quantitative (ie, longitudinal, cross-sectional or cohort surveys) descriptions of self-reported perceived barriers to quitting smoking in one of the six aforementioned vulnerable groups were included. Two authors independently assessed studies for inclusion and extracted data. 65 eligible papers were identified: 24 with low socioeconomic groups, 16 with Indigenous groups, 18 involving people with a mental illness, 3 with homeless groups, 2 involving prisoners and 1 involving at-risk youth. One study identified was carried out with participants who were homeless and addicted to alcohol and/or other drugs. Barriers common to all vulnerable groups included: smoking for stress management, lack of support from health and other service providers, and the high prevalence and acceptability of smoking in vulnerable communities. Unique barriers were identified for people with a mental illness (eg, maintenance of mental health), Indigenous groups (eg, cultural and historical norms), prisoners (eg, living conditions), people who are homeless (eg, competing priorities) and at-risk youth (eg, high accessibility of tobacco). Vulnerable groups experience common barriers to smoking cessation, in addition to barriers that are unique to specific vulnerable groups. Individual-level, community-level and social network-level interventions are priority areas for future smoking cessation interventions within vulnerable groups. A protocol for this review has been registered with PROSPERO International Prospective Register of Systematic Reviews (Identifier: CRD42013005761). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
... A prospective study published in 1990 examined the relation between changes in stress levels and changes in smoking status, and concluded that the relation was possibly bidirectional [5]. Although the association between changes in smoking status and changes in stress levels was consistently observed in other studies [22,26], the causal direction remains uncertain. In a recent study by Taylor and colleagues [13], deterioration in mental health after achieving and maintaining abstinence until four months did not predict relapse to smoking by 12 months. ...
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Background Previous studies have shown that smoking and smoking cessation may be associated with health-related quality of life (HRQoL). In this study, we compared changes in HRQoL in people who maintained abstinence with people who had relapsed to smoking. Methods This was a secondary analysis of data from a trial of a relapse prevention intervention in 1,407 short-term quitters. The European Quality of Life -5 Dimensions (EQ-5D) measured HRQoL at baseline, 3 and 12 months. Smoking outcome was continuous abstinence from 2 to 12 months, and 7-day smoking at 3 and 12 months. We used nonparametric test for differences in EQ-5D utility scores, and chi-square test for dichotomised response to each of the five EQ-5D dimensions. Multivariable regression analyses were conducted to evaluate associations between smoking relapse and HRQoL or anxiety/depression problems. Results The mean EQ-5D tariff score was 0.8252 at baseline. People who maintained abstinence experienced a statistically non-significant increase in the EQ-5D score (mean change 0.0015, P = 0.88), while returning to smoking was associated with a statistically significant decrease in the EQ-5D score (mean change -0.0270, P = 0.004). After adjusting for multiple baseline characteristics, the utility change during baseline and 12 months was statistically significantly associated with continuous abstinence, with a difference of 0.0288 (95% CI: 0.0006 to 0.0571, P = 0.045) between relapsers and continuous quitters. The only difference in quality of life dimensions between those who relapsed and those who maintained abstinence was in the proportion of participants with anxiety/depression problems at 12 months (30% vs. 22%, P = 0.001). Smoking relapse was associated with a simultaneous increase in anxiety/depression problems. Conclusions People who achieve short-term smoking abstinence but subsequently relapse to smoking have a reduced quality of life, which appears mostly due to worsening of symptoms of anxiety and depression. Further research is required to more fully understand the relationship between smoking and health-related quality of life, and to develop cessation interventions by taking into account the impact of anxiety or depression on smoking.
... The literature on changes in mental health status in association with changes in tobacco use is more extensive. A meta-analysis of 26 studies (Taylor et al., 2014) (none including hospitalized patients) found smoking cessation also led to reductions in measures of anxiety (McDermott et al., 2013;Steinberg et al., 2011), depression (Steinberg et al., 2011;Munafò et al., 2008), and stress (Hajek et al., 2010). ...
Article
Few rigorous longitudinal assessments have examined health-related quality of life (HRQoL) changes after smoking cessation, especially among recently-hospitalized smokers. We compared the change in HRQoL between those who did or did not quit smoking 6 months after hospital discharge. Participants were 1357 smokers recruited for a cessation trial between 2012 and 2014 while hospitalized at two hospitals in Massachusetts and one in Pennsylvania. Cessation was defined as biochemically confirmed 7-day point prevalence abstinence at 6 months or as self-reported continuous abstinence at 1, 3, or 6 months post discharge. HRQoL measures included a single-item global health measure (SF1); the Patient Health Questionnaire for Depression and Anxiety (PHQ-4) screening tool for psychological distress; and the EQ-5D-5L health utilities measure. Multivariable models controlled for age, sex, race, education, insurance, study site, study arm, discharge diagnoses, and baseline HRQoL. Improvements in HRQoL were evident in the first month after discharge among those achieving abstinence compared to continuing smokers. At 6 months post-discharge, those with biochemically confirmed cessation were 30% more likely to report at least good health by the SF1 (aRR 95% CI 1.14-1.45), 19% less likely to screen positive for psychological distress (aRR, 95% CI 0.68-0.93), and had EQ-5D-5L health utility scores 0.05 points (95% CI 0.02-0.08) higher than continuing smokers. Results were similar when assessed as a function of self-reported cessation. Hospital-initiated smoking cessation is associated with rapid statistically and clinically significant improvements in a range of HRQoL measures, providing an additional tool clinicians and health systems could use to encourage smoking cessation.
... There was a decrease in mean stress levels in the smoking cessation group (4.4 points, 95% CI 4.1-4.8) compared to the current-smoker group (5.2 points, 95% CI 4.9-5.6) in a study by Hajek et al. [30]. However, it was hard to find data about stress levels in the smoking-relapsed group in published reports. ...
Article
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Background Cigarette smoking is a major health risk, particularly in male South Koreans. Smoking cessation can benefit health; however, the process of quitting smoking is difficult to some smokers and shows its relationship to their stress level. The hypothesis of this study is that who has failed attempts to stop smoking induce more stress than habitual smoking. Methods To test this, the analysis on the association between smoking cessation attempts and stress levels in smokers was performed. The Korean Community Health Survey (2011–2016) data with the total of 488,417 participants’ data were used for this study. Survey data were analyzed using the chi-square test and logistic regression. As the dependent variable, self-reported level of stress was selected. Results Of the subject population, 78.3% (63.3% males, 81.4% females) felt stressed. Among participants who successfully stopped smoking, 73.0% (72.6% males, 78.1% females) reported feeling stressed. In contrast, of those who failed to stop smoking, 83.3% (83.6% males, 86.3% females) reported high stress levels. Among those who did not attempt smoking cessation, 81.1% (81.2% males, 80.3% females) responded that they experienced stress. Those who failed to stop smoking had higher odds of stress than those who did not attempt smoking cessation [odds ratio (OR) 1.11, 95% confidence interval (CI) 1.09–1.14, p < 0.001]. Those who successfully stopped smoking had lower odds of stress than those who did not attempt smoking cessation (OR 0.87, 95% CI 0.86–0.89, p < 0.001). Conclusion The study found an association between unsuccessful smoking cessation and stress level. As the result, people who failed smoking cessation showed higher stress. These data should be considered in health policy recommendations for smokers. Electronic supplementary material The online version of this article (10.1186/s12889-019-6592-9) contains supplementary material, which is available to authorized users.
... There are number of theories specifying the role of stress on nicotine abuse behaviours. The conventional idea is that nicotine abuse may temporarily relieve stress but it exerts negative impacts on emotional state and coping (Hajek et al., 2010). A recent study reported an association between perceived stress and psychological distress (Hobkirk et al., 2018). ...
Article
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An interdisciplinary review of the literature portrayed stress as an important cause for nicotine abuse among university students. Independent studies have shown nicotine to contribute perceived stress (PS) and oxidative stress (OS) but its mediation relation with PS and OS remains unclear and inspires active exploration. A prominent study on the relationship of smoking with perceived stress and coping styles in adolescents motivates to study the effect of nicotine abuse (NA) on PS, CSE, and OS indices among young adult university graduates. The study sample included 45 university graduates with 1-3 years of tobacco abuse history and 50 age-matched controls. The respondents were compared for perceived stress scale (PSS) score, coping self-efficacy (CSE) score, erythrocyte malondialdehyde (E_MDA), plasma MDA (P_MDA), erythrocyte superoxide dismutase (E_SOD), and plasma catalase (P_CAT). The study found NA increased the PS but not the CSE. Linear regression analysis showed a strong inverse relation between the PSS Score and CSE Score in the controls. Among the biochemical indices of OS, only P_MDA showed a significant difference between the groups. Multiple regressions showed a significant positive association of E_MDA with PSS Score and a significant negative association of E_SOD with PSS Score across the groups. Further, the mediation model is used to show a significant relationship between NA and PSS Score by Combined MDA (C_MDA). The result of study suggested that nicotine increases PS and reduces CSE. P_MDA is an important biochemical marker of nicotine abuse. E_MDA and E_SOD are important predictors of PS. These findings are important for psychobiochemical interventions in the management of NA. Therefore, this study encourages an interdisciplinary discourse on nicotine abuse with psychological and biochemical measures.
... Similar longitudinal research in other settings has found mixed results, with most finding no significant results and some finding baseline higher perceived stress associated with fewer smokers successfully quitting, and none finding it associated with more smokers successfully quitting, as we did. [37][38][39][40][41][42][43][44] Unlike this previous longitudinal research that has concentrated on quit success, we assessed starting and sustaining quit attempts separately, acknowledging the different behavioural processes involved. 5 We have more confidence in our unexpected results because they were not greatly changed after controlling for known predictors of starting and sustaining quit attempts. ...
Article
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Objective : To examine whether baseline measures of stress, life satisfaction, depression and alcohol use predict making or sustaining quit attempts in a national cohort of Aboriginal and Torres Strait Islander smokers. Methods : We analysed data from the nationally representative quota sample of 1,549 Aboriginal and Torres Strait Islander adults who reported smoking at least weekly in the Talking About The Smokes baseline survey (April 2012–October 2013) and the 759 who completed a follow‐up survey a year later (August 2013–August 2014). Results : More smokers who reported negative life satisfaction, feeling depressed, higher stress or drinking heavily less often than once a week at baseline made a quit attempt between the baseline and follow‐up surveys. In contrast, of these smokers who had made quit attempts between surveys, more who reported higher stress were able to sustain abstinence for at least one month; other associations were inconclusive. Conclusions and implications for public health : Health staff and Aboriginal and Torres Strait Islander smokers need not see being more stressed as an obstacle to quitting among Aboriginal and Torres Strait Islander people. Health staff should emphasise the benefits to mental health that come with successfully quitting smoking.
... Although studies have not been conducted with homeless smokers specifically, a number of studies show that smoking cessation is actually associated with lower rates of mood/anxiety disorders and perceived stress, including among individuals with a history of mental disorders. 6,7,9,10 Treatment Effectiveness. In general, "more is better" when it comes to smoking cessation treatment. ...
... These results suggest that smoking cessation helps people to cope with stress better, which is consistent with the findings of previous studies. Hajek and colleagues reported that smoking cessation for a period of 1 year decreased perceived stress in 194 abstainers as compared to 275 continued smokers [9]. Further studies are needed to examine the effects of smoking cessation on coping skills and perceived stress levels. ...
Article
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There are many studies on how smoking cigarettes is harmful to health, but research on how smoking cessation improves mental health is insufficient. The purpose of this study was to examine long-term effects of smoking cessation on depressive symptoms, resilience, coping skills, and serotonin levels in Korean adults. This was a longitudinal study that followed up on periodically participants for 2 years after the initial smoking cessation intervention. A total of 164 smokers participated within this study. Of these, 15 maintained smoking cessation for 504.93 ± 182.82 days. On the other hand, 148 participants failed to maintain smoking cessation. Depressive symptoms decreased and resilience increased significantly over 2 years in the 15 abstainers. Smoking cessation, in total, decreased depressive symptoms by 32.9% (p = .015) and also increased resilience by 37.5% (p = .012). Smoking cessation also explained for 9% of total positive interpretation at the 1-year follow-up, and 7.3% of total self-criticism at the 2-year follow-up. Serum serotonin did not change over the course of 2 years in both abstainers and smokers but did decrease in the short-term for those who maintained smoking cessation. Platelet serotonin increased over 6 months among smokers.
... This is in line with previous findings showing that stress is a main mechanism in initiating smoking behaviour. 22,23 This relationship, once more emerged only between the pre measurement of Cigarette Craving, while post measures and measure of Coping Difficulties did not correlate with either physiological or selfreported measures of stress. In particular, it should be noted that the absence of a correlation between post measures of Cigarette Craving and perceived stress, suggests that craving experienced after the experiment is more likely to be due to the interven-tion than to stress experienced before watching the movie clips. ...
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Αn abundance of research has demonstrated that substance addicted individuals, when they are exposed to a substance related stimulus, show a positive correlation between physiological measurements, such as an increase in heart rate and sweating, and behavioral reactions, that include craving and substance use or consumption. Films depicting smoking behavior are regarded as cues to induce smoking behavior. The current study aimed to investigate the effects of smoking behavior portrayed in movies on actual craving experienced by smokers who watch on screen actors consume tobacco products. In addition, the effects of receiving orally administered nicotine (chewing gum), a regular chewing gum or no additional intervention were examined. In particular, the study aimed to investigate how these factors impact nicotine craving as well as the heart rate and sweating. The majority of the participants were University of Bedfordshire students and staff. Thirty smokers (12 males and 18 females) having received a nicotine gum, a regular chewing gum or no gum, were exposed to a digital video clip showing actors smoking. The participants chose the type of chewing gum they wanted. Heart rate (HR) and galvanic skin response (GSR) were measured during the course of the experiment. Prior to and after watching the movie clip participants completed the Brief Questionnaire of Smoking Urges (QSU-Brief) and the Perceived Stress Scale (PSS). According to the results, the craving was increased when compared to the baseline score (t=-3.76, p<0.001). Additionally, a correlation was found between the baseline level of craving and perceived stress before and after the movie (r=0.39). Nicotine chewing gum was found to have a significant impact on participants' heart rate (p<0.05) but not on GSR. A significant difference was found in participants in the normal chewing gum condition reporting higher levels of craving than the other two groups (p<0.05). Age was found to positively related to post-measures of nicotine craving which was found to be higher for young respondents (r=-0.47, p<0.01). The data further show that the depiction of smoking behavior in the media is likely to have a significant impact on smoking craving, smoking behavior and nicotine consumption. The current study confirms and replicates some of the previous findings within the field of smoking behavior and nicotine craving such as high susceptibility of younger adults to media influence.
... In our study, we found that exsmokers had much lower odds of perceived high stress levels than daily smokers, but not as low as never smokers. Previous studies confirm that smoking cessation is associated with decreased, not increased stress 29,30 , even in highly dependent smokers who reported that smoking helped them cope with stress 29 . A systematic review, based on 23 studies, concluded that smoking cessation was associated with a decrease in stress levels and an increase in positive mood compared to continuing smoking 30 . ...
Article
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Introduction: The social pressure placed on smokers today might potentially lead to an increasing level of stress. We investigated if the proportion of persons with high stress level had increased over time more in smokers than in non-smokers. Methods: Data were obtained from repeated cross-sectional surveys of The Capital Region Health Survey conducted in 2010, 2013 and 2017. Survey data were weighted for survey design and non-response, and linked to national register data. Cohens Perceived Stress Scale (PSS-10) score was used. Logistic regression analyses, based on 136608 citizens' self-reports, were adjusted for sex, age, education level, employment, and alcohol intake (and loneliness, in analysis investigating the associations between tobacco consumption and high stress level). Results: A significantly higher proportion of citizens reported a high stress level in 2017 compared with 2010 and 2013 but there was not a greater increase in smokers than in non-smokers. Daily smoking men had 69% higher odds of reporting perceived high stress level and daily smoking women had 36% higher odds, than never smokers of the same sex. There was a significant trend between higher daily tobacco consumption and a higher proportion of smokers with high stress level. Conclusions: The increase in high stress level over time occurred independently of smoking status. Daily smokers had the highest odds of perceived high stress level, and a higher daily tobacco consumption was associated with a higher proportion of smokers with high stress level. Smoking cessation programs should, to a higher degree, consider implementing stress-coping elements to prevent relapse.
... • According to new research published in the journal of Addiction, smoking and anxiety disorders are linked, and massage therapy has been shown to lessen the anxiety 12 that could be driving people to smoke. In some cases, you can place a small bead on the point and hold it in place with tape. ...
... In addition, people who experience socioeconomic disadvantage also experience more stressful events and have fewer resources to successfully cope with this stress [10][11][12][13]. This, in turn, might lead to increased smoking as a maladaptive way of coping with the stress [14]; essentially, that some people may engage in smoking as a means of coping with stress [15,16]. ...
Article
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Background: There is a well-established social gradient in smoking, but little is known about the underlying behavioral mechanisms. Here, we take a social-ecological perspective by examining daily stress experience as a process linking social disadvantage to smoking behavior. Method: A sample of 194 daily smokers, who were not attempting to quit, recorded their smoking and information about situational and contextual factors for three weeks using an electronic diary. We tested whether socioeconomic disadvantage (indicated by educational attainment, income and race) exerts indirect effects on smoking (cigarettes per day) via daily stress. Stress experience was assessed at the end of each day using Ecological Momentary Assessment methods. Data were analyzed using random effects regression with a lower-level (2-1-1) mediation model. Results: On the within-person level lower educated and African American smokers reported significantly more daily stress across the monitoring period, which in turn was associated with more smoking. This resulted in a small significant indirect effect of daily stress experience on social disadvantage and smoking when using education and race as indicator for social disadvantage. No such effects were found when for income as indicator for social disadvantage. Conclusion: These findings highlight the potential for future studies investigating behavioral mechanisms underlying smoking disparities. Such information would aid in the development and improvement of interventions to reduce social inequality in smoking rates and smoking rates in general.
... Regarding the participants' lifestyle characteristics, we observed that physically active people are less likely to have higher levels of perceived stress compared to inactive people, while current smokers were more likely to have a higher score of perceived stress scale compared to non-smokers. Although, a common belief is that smoking reduces stress, previous research suggests that smoking could be associated with altered functioning of the HPA axis and the Autonomic Nervous System (ANS) (27), that may generate or aggravate negative emotional states and propagate negative coping strategies leading to overall higher stress levels (28)(29)(30). With regards to physical activity, possible mechanism hypotheses suggest that it neutralizes the effects of psychological stressors on cardiac reactivity and dampens stressor-evoked increases in stress hormones and serotonin (31)(32)(33), whilst physical activity could also enhance mental health via changes in the structural and functional composition of the brain (34). ...
Article
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The COVID-19 pandemic is a serious global health emergency that could potentially have a significant impact on both somatic as well as psychological level. The aim of this study was to assess the prevalence of perceived stress in the general adult population of Cyprus during the first COVID-19 lockdown period. This was an internet-based cross-sectional study conducted between 6 April and 20 June 2020, one to two and a half months after the introduction of and the first mandatory lockdown on its entire territory imposed by the government of the Republic of Cyprus on 24 March 2020. Data collection was done using a self-administered questionnaire that included information about socioeconomic and demographic characteristics, physical activity, smoking habits, and stress level. A total of 1,485 adults participated in the study. The median perceived stress score was 10 (q1 = 6, q3 = 15). Linear regression models showed that having a medium monthly income (€501-1,500) and being a current smoker was positively associated with the perceived stress score, while being male and physically active was negatively associated with the perceived stress score (all p <0.05). People with medium average salary and current smokers were at a higher risk for perceived stress. Psychological interventions and/or psychological services provided in certain vulnerable groups would be beneficial in future lockdowns due to either COVID-19 or a new pandemic.
... Smokers, in turn, often perceive cigarettes as a stress relief [60]. There is a piece of experimental evidence that smoking during unpleasant circumstances may decrease the level of arousal resulting in temporary stress relief, [61] although studies have also shown that smoking may eventually lead to generation or aggravation of negative emotional states, support adverse coping strategies, and increase the overall stress level [62][63][64]. Whether increased smoking during the lockdown may result in a higher consumption of cigarettes in the future remains unknown. ...
Article
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The outbreak of coronavirus disease (COVID-19) in late December 2019 in China, which later developed into a pandemic, has forced different countries to implement strict sanitary regimes and social distancing measures. Globally, at least four billion people were under lockdown, working remotely, homeschooling children, and facing challenges coping with quarantine and the stressful events. The present cross-sectional online survey of adult Poles (n = 1097), conducted during a nationwide quarantine, aimed to assess whether nutritional and consumer habits have been affected under these conditions. Over 43.0% and nearly 52% reported eating and snacking more, respectively, and these tendencies were more frequent in overweight and obese individuals. Almost 30% and over 18% experienced weight gain (mean ± SD 3.0 ± 1.6 kg) and loss (−2.9 ± 1.5 kg), respectively. Overweight, obese, and older subjects (aged 36–45 and >45) tended to gain weight more frequently, whereas those with underweight tended to lose it further. Increased BMI was associated with less frequent consumption of vegetables, fruit, and legumes during quarantine, and higher adherence to meat, dairy, and fast-foods. An increase in alcohol consumption was seen in 14.6%, with a higher tendency to drink more found among alcohol addicts. Over 45% of smokers experienced a rise in smoking frequency during the quarantine. The study highlights that lockdown imposed to contain an infectious agent may affect eating behaviors and dietary habits, and advocates for organized nutritional support during future epidemic-related quarantines, particularly for the most vulnerable groups, including overweight and obese subjects.
Article
This is an update of a Cochrane review previously published in 2008. Smoking increases the risk of developing atherosclerosis but also acute thrombotic events. Quitting smoking is potentially the most effective secondary prevention measure and improves prognosis after a cardiac event, but more than half of the patients continue to smoke, and improved cessation aids are urgently required. This review aimed to examine the efficacy of psychosocial interventions for smoking cessation in patients with coronary heart disease in short-term (6 to 12 month follow-up) and long-term (more than 12 months). Moderators of treatment effects (i.e. intervention types, treatment dose, methodological criteria) were used for stratification. The Cochrane Central Register of Controlled Trials (Issue 12, 2012), MEDLINE, EMBASE, PsycINFO and PSYNDEX were searched from the start of the database to January 2013. This is an update of the initial search in 2003. Results were supplemented by cross-checking references, and handsearches in selected journals and systematic reviews. No language restrictions were applied. Randomised controlled trials (RCTs) in patients with CHD with a minimum follow-up of 6 months. Two authors independently assessed trial eligibility and risk of bias. Abstinence rates were computed according to an intention to treat analysis if possible, or if not according to completer analysis results only. Subgroups of specific intervention strategies were analysed separately. The impact of study quality on efficacy was studied in a moderator analysis. Risk ratios (RR) were pooled using the Mantel-Haenszel and random-effects model with 95% confidence intervals (CI). We found 40 RCTs meeting inclusion criteria in total (21 trials were new in this update, 5 new trials contributed to long-term results (more than 12 months)). Interventions consist of behavioural therapeutic approaches, telephone support and self-help material and were either focused on smoking cessation alone or addressed several risk factors (eg. obesity, inactivity and smoking). The trials mostly included older male patients with CHD, predominantly myocardial infarction (MI). After an initial selection of studies three trials with implausible large effects of RR > 5 which contributed to substantial heterogeneity were excluded. Overall there was a positive effect of interventions on abstinence after 6 to 12 months (risk ratio (RR) 1.22, 95% confidence interval (CI) 1.13 to 1.32, I² 54%; abstinence rate treatment group = 46%, abstinence rate control group 37.4%), but heterogeneity between trials was substantial. Studies with validated assessment of smoking status at follow-up had similar efficacy (RR 1.22, 95% CI 1.07 to 1.39) to non-validated trials (RR 1.23, 95% CI 1.12 to 1.35). Studies were stratified by intervention strategy and intensity of the intervention. Clustering reduced heterogeneity, although many trials used more than one type of intervention. The RRs for different strategies were similar (behavioural therapies RR 1.23, 95% CI 1.12 to 1.34, I² 40%; telephone support RR 1.21, 95% CI 1.12 to 1.30, I² 44%; self-help RR 1.22, 95% CI 1.12 to 1.33, I² 40%). More intense interventions (any initial contact plus follow-up over one month) showed increased quit rates (RR 1.28, 95% CI 1.17 to 1.40, I² 58%) whereas brief interventions (either one single initial contact lasting less than an hour with no follow-up, one or more contacts in total over an hour with no follow-up or any initial contact plus follow-up of less than one months) did not appear effective (RR 1.01, 95% CI 0.91 to 1.12, I² 0%). Seven trials had long-term follow-up (over 12 months), and did not show any benefits. Adverse side effects were not reported in any trial. These findings are based on studies with rather low risk of selection bias but high risk of detection bias (namely unblinded or non validated assessment of smoking status). Psychosocial smoking cessation interventions are effective in promoting abstinence up to 1 year, provided they are of sufficient duration. After one year, the studies showed favourable effects of smoking cessation intervention, but more studies including cost-effectiveness analyses are needed. Further studies should also analyse the additional benefit of a psychosocial intervention strategy to pharmacological therapy (e.g. nicotine replacement therapy) compared with pharmacological treatment alone and investigate economic outcomes.
Article
Stress has been found to be a significant risk factor for cigarette smoking. Stress affects males and females differently, as does the use of smoking for stress reduction. Few studies have examined gender differences with the interrelation of perceived stress and smoking behaviors and nicotine related symptomatology. Our study investigates this association, as well as the influence of sociodemographic variables. This is a retrospective analysis of 62 smokers (41 males, 21 females) enrolled in a smoking cessation study. At the screening visit sociodemographic information, smoking behaviors and survey measures were completed. These included the Perceived Stress Scale (PSS), Minnesota Nicotine Withdrawal Scale (MNWS), and others. Analyses were conducted using multiple linear regression models. PSS score was found to have a negative association with number of cigarettes smoked in males (slope -0.29±0.08; p=0.0009) and females (slope -0.20±0.18; p=0.26) with no difference in effect between genders (p=0.64). Linear regression of MNWS on PSS revealed a positive association for both males (slope 0.41±0.068; p<0.0001) and females (slope 0.73±0.14; p<0.0001). There was a significant difference in effect between genders (p=0.04). A strong positive association was observed between perceived stress and nicotine withdrawal symptomatology in smokers of both sexes, with a larger effect seen in women. These findings emphasize the importance of stress reduction in smokers, which may lead to fewer withdrawal symptoms and more effective smoking cessation. Copyright © 2015 Elsevier Ltd. All rights reserved.
Research
The tobacco is an important risk factor for development of cardiovascular diseases. Hospitalization of these patients gives us an excellent opportunity to help them to quit smoking. However, few studies have evaluated what type of intervention is most effective for this population. Therefore, the aim of this study is to review treatments for smoking cessation that have been applied to patients hospitalized with cardiovascular disease in the last decade, in order to determine their effectiveness and establish what would be most appropriate. To achieve this, we searched the Cochrane Tobacco registration Addiction Group and the databases Medline, PsycInfo, PubMed, and CSIC. As a consequence, 16 studies fulfilling inclusion criteria were found, although treatments components and intensity differ greatly from one study to another. It was concluded that while brief advice increases cessation compared with no intervention, the most effective interventions are those of greater intensity that last for at least three months after hospital discharge.
Article
Background Smoking is an important cardiovascular risk factor and smoking cessation should be a primary target in secondary prevention after a myocardial infarction (MI). Purpose The purpose of this study was to examine whether personality, coping and depression were related to smoking cessation after an MI. Method MI patients ≤70 years (n = 323, 73 % men, 58.7 ± 8.3 years), participating in the Secondary Prevention and Compliance following Acute Myocardial Infarction study in Malmö, Sweden, between 2002 and 2005, were interviewed by a psychologist to assess coping strategies and completed Beck Depression and NEO Personality Inventories, in close proximity to the acute event. Correlation between smoking status (current, former and never), personality factors, coping and depression was assessed at baseline and 24 months after the MI using logistic regression and in a multivariate analysis, adjusting for age and sex. Results Of the participating patients, 46 % were current smokers. Two years after the event, 44 % of these were still smoking. At baseline, current smokers scored higher on the depression and neuroticism scales and had lower agreeableness scores. Patients who continued to smoke after 2 years had higher scores on being confrontational (i.e. confrontative coping style) compared to those who had managed to quit. Patients who continued to smoke had significantly lower agreeableness and were more often living alone. Conclusion Personality, coping strategies and psychosocial circumstances are associated with smoking cessation rates in patients with MI. Considering personality factors and coping strategies to better individualise smoking cessation programs in MI patients might be of importance.
Article
Background: There is a common perception that smoking generally helps people to manage stress, and may be a form of 'self-medication' in people with mental health conditions. However, there are biologically plausible reasons why smoking may worsen mental health through neuroadaptations arising from chronic smoking, leading to frequent nicotine withdrawal symptoms (e.g. anxiety, depression, irritability), in which case smoking cessation may help to improve rather than worsen mental health. Objectives: To examine the association between tobacco smoking cessation and change in mental health. Search methods: We searched the Cochrane Tobacco Addiction Group's Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, and the trial registries clinicaltrials.gov and the International Clinical Trials Registry Platform, from 14 April 2012 to 07 January 2020. These were updated searches of a previously-conducted non-Cochrane review where searches were conducted from database inception to 13 April 2012. SELECTION CRITERIA: We included controlled before-after studies, including randomised controlled trials (RCTs) analysed by smoking status at follow-up, and longitudinal cohort studies. In order to be eligible for inclusion studies had to recruit adults who smoked tobacco, and assess whether they quit or continued smoking during the study. They also had to measure a mental health outcome at baseline and at least six weeks later. Data collection and analysis: We followed standard Cochrane methods for screening and data extraction. Our primary outcomes were change in depression symptoms, anxiety symptoms or mixed anxiety and depression symptoms between baseline and follow-up. Secondary outcomes included change in symptoms of stress, psychological quality of life, positive affect, and social impact or social quality of life, as well as new incidence of depression, anxiety, or mixed anxiety and depression disorders. We assessed the risk of bias for the primary outcomes using a modified ROBINS-I tool. For change in mental health outcomes, we calculated the pooled standardised mean difference (SMD) and 95% confidence interval (95% CI) for the difference in change in mental health from baseline to follow-up between those who had quit smoking and those who had continued to smoke. For the incidence of psychological disorders, we calculated odds ratios (ORs) and 95% CIs. For all meta-analyses we used a generic inverse variance random-effects model and quantified statistical heterogeneity using I2. We conducted subgroup analyses to investigate any differences in associations between sub-populations, i.e. unselected people with mental illness, people with physical chronic diseases. We assessed the certainty of evidence for our primary outcomes (depression, anxiety, and mixed depression and anxiety) and our secondary social impact outcome using the eight GRADE considerations relevant to non-randomised studies (risk of bias, inconsistency, imprecision, indirectness, publication bias, magnitude of the effect, the influence of all plausible residual confounding, the presence of a dose-response gradient). Main results: We included 102 studies representing over 169,500 participants. Sixty-two of these were identified in the updated search for this review and 40 were included in the original version of the review. Sixty-three studies provided data on change in mental health, 10 were included in meta-analyses of incidence of mental health disorders, and 31 were synthesised narratively. For all primary outcomes, smoking cessation was associated with an improvement in mental health symptoms compared with continuing to smoke: anxiety symptoms (SMD -0.28, 95% CI -0.43 to -0.13; 15 studies, 3141 participants; I2 = 69%; low-certainty evidence); depression symptoms: (SMD -0.30, 95% CI -0.39 to -0.21; 34 studies, 7156 participants; I2 = 69%' very low-certainty evidence); mixed anxiety and depression symptoms (SMD -0.31, 95% CI -0.40 to -0.22; 8 studies, 2829 participants; I2 = 0%; moderate certainty evidence). These findings were robust to preplanned sensitivity analyses, and subgroup analysis generally did not produce evidence of differences in the effect size among subpopulations or based on methodological characteristics. All studies were deemed to be at serious risk of bias due to possible time-varying confounding, and three studies measuring depression symptoms were judged to be at critical risk of bias overall. There was also some evidence of funnel plot asymmetry. For these reasons, we rated our certainty in the estimates for anxiety as low, for depression as very low, and for mixed anxiety and depression as moderate. For the secondary outcomes, smoking cessation was associated with an improvement in symptoms of stress (SMD -0.19, 95% CI -0.34 to -0.04; 4 studies, 1792 participants; I2 = 50%), positive affect (SMD 0.22, 95% CI 0.11 to 0.33; 13 studies, 4880 participants; I2 = 75%), and psychological quality of life (SMD 0.11, 95% CI 0.06 to 0.16; 19 studies, 18,034 participants; I2 = 42%). There was also evidence that smoking cessation was not associated with a reduction in social quality of life, with the confidence interval incorporating the possibility of a small improvement (SMD 0.03, 95% CI 0.00 to 0.06; 9 studies, 14,673 participants; I2 = 0%). The incidence of new mixed anxiety and depression was lower in people who stopped smoking compared with those who continued (OR 0.76, 95% CI 0.66 to 0.86; 3 studies, 8685 participants; I2 = 57%), as was the incidence of anxiety disorder (OR 0.61, 95% CI 0.34 to 1.12; 2 studies, 2293 participants; I2 = 46%). We deemed it inappropriate to present a pooled estimate for the incidence of new cases of clinical depression, as there was high statistical heterogeneity (I2 = 87%). Authors' conclusions: Taken together, these data provide evidence that mental health does not worsen as a result of quitting smoking, and very low- to moderate-certainty evidence that smoking cessation is associated with small to moderate improvements in mental health. These improvements are seen in both unselected samples and in subpopulations, including people diagnosed with mental health conditions. Additional studies that use more advanced methods to overcome time-varying confounding would strengthen the evidence in this area.
Article
Background Black adults in the U.S. experience significant health disparities related to tobacco use and obesity. Conducting observational studies of the associations between smoking and other health behaviors and indicators among Black adults may contribute to the development of tailored interventions. Purpose We examined associations between change in cigarette smoking and alcohol use, body mass index, eating behavior, perceived stress, and self-rated health in a cohort of Black adults who resided in low-income urban neighborhoods and participated in an ongoing longitudinal study. Methods Interviews were conducted in 2011, 2014, and 2018; participants (N = 904) provided at least two waves of data. We fit linear and logistic mixed-effects models to evaluate how changes in smoking status from the previous wave to the subsequent wave were related to each outcome at that subsequent wave. Results Compared to repeated smoking (smoking at previous and subsequent wave), repeated nonsmoking (nonsmoking at previous and subsequent wave) was associated with greater likelihood of recent dieting (OR = 1.59, 95% CI [1.13, 2.23], p = .007) and future intention (OR = 2.19, 95% CI [1.61, 2.98], p < .001) and self-efficacy (OR = 1.64, 95% CI [1.21, 2.23], p = .002) to eat low calorie foods, and greater odds of excellent or very good self-rated health (OR = 2.47, 95% CI [1.53, 3.99], p < .001). Transitioning from smoking to nonsmoking was associated with greater self-efficacy to eat low calorie foods (OR = 1.89, 95% CI [1.1, 3.26], p = .021), and lower perceived stress (β = −0.69, 95% CI [−1.34, −0.05], p = .036). Conclusions We found significant longitudinal associations between smoking behavior and eating behavior, perceived stress, and self-rated health. These findings have implications for the development of multiple behavior change programs and community-level interventions and policies.
Article
Background: The COVID-19 pandemic and associated public health prevention measures (e.g., "stay at home" orders) may impact tobacco supply and demand among consumers. This qualitative study identified multi-level drivers of shifts in inhaled tobacco product use and access patterns during the initial COVID-19 "lockdown" period in the United States. Methods: Between April⁠-May 2020, we conducted semi-structured telephone interviews (n = 44) with adults who use cigarettes and/or electronic nicotine delivery systems (ENDS). Transcripts were thematically analyzed using a socioecological framework. Results: Nearly all participants reported changes in their product use during lockdown, though patterns varied. Increased use was most common and was predominantly driven by individual-level factors: pandemic-related anxiety, boredom, and irregular routines. Decreased use was common among social users who cited fewer interpersonal interactions and fear of sharing products. At the community level, retail access impacted cigarette and ENDS use differently. While cigarettes were universally accessible, ENDS access was more limited, driving some to purchase products online. Delayed deliveries led some ENDS users to compensate with readily-available cigarettes. Conclusion: To mitigate ways that the COVID-19 pandemic may exacerbate an existing public health crisis, multi-level policy strategies, such as expanded virtual cessation services and implementation and enforcement of smoke-free home rules, can better support population health during this critical period. Policies that facilitate access to lower risk products can help minimize harm among those who cannot or do not want to quit smoking.
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Smokers with mental illness are motivated to stop smoking and can quit successfully, usually without any exacerbation of their mental illness. GPs should be proactive in helping these patients to quit.
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Objectives: The purpose of this study is to examine the effect of the raise of cigarette prices by KRW 2,000 at the beginning of 2015 on the change in smoking behavior among male office workers, and to analyze the correlation of various factors including their work behaviors and socio-economic factors with their smoking rate. Methods: In this research, a follow-up observation panel was constituted with 420 smokers as targets from among male office workers at a bank located in Daegu, South Korea. A cross-analysis and ANOVA analysis were carried out in order to examine whether changes in smoking status, amount of smoking, stop-smoking motivation, and reasons for smoking cessation failure after the passage of time since the cigarette price hike were statistically significant. The level of statistical significance was P
Chapter
Depressive vulnerability (eg, history of major depressive disorders, subclinical depressive symptoms, and anhedonia) is associated with greater smoking prevalence, relapse, and nicotine dependence; however, the relationship between such depression-related measures and withdrawal symptom severity and trajectories, or what may be described as mental health measures following reduction or cessation of smoking, is less well established because of methodological limitations of most relevant studies. Major limitations of studies to date are related to the failure to control for or to carefully assess four factors: (1) differential dropout: substantial nonrandom study dropout and relapse in individuals with depressive vulnerability and more generally in individuals with the most severe withdrawal symptoms and stressful life events; (2) testing effects: the strong tendency for scores on measures of negative affect and withdrawal symptoms to decrease substantially with repeated testing across time (given a constant environment stress-potential); (3) anticipatory quit stress: increased prequit anticipatory negative affect and withdrawal symptom scores in the week or so prior to quit attempts; and (4) long- and short-term chronodynamic life changes: to date, generally uncharacterized factors (generally disguised as error variance in statistical analyses) such as individual variability in short and long-term stressors, life circumstances, and biological functioning independent of or interacting with smoking abstinence effects and the decision to quit smoking at a given time. A model that addresses these four threats to accurate characterization of withdrawal symptoms is presented.
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Behavior and substance use addictions are increasingly prevalent in children with increased risk for substance abuse and mental health diagnoses in adulthood. This article proposes a comprehensive model of addiction to inform research on the prevention and treatment of childhood addiction, emphasizing skills training, mindfulness training, and broader treatment strategies consistent with acceptance and commitment therapy.
Article
Objective To clarify the prevalence of stress, and examine the relationship between sleep disorders and stress coping strategies among highly stressed individuals in the general Japanese population. Methods A cross-sectional nationwide survey was undertaken in November 2007. Men and women were randomly selected from 300 districts throughout Japan. Data from 7671 (3532 men (average age 53.5 ± 17.0 years) and 4139 women (average age 53.9 ± 17.7 years)) were analyzed. Participants completed a self-reported questionnaire on stress, sleep disorders, and stress coping strategies in the previous month. Results Highly stressed individuals comprised 16.6% (95% confidence interval 15.8–17.5%) of the total sample, and most were aged 20–49 years. In multiple logistic regression, symptoms of insomnia (ie, difficulty initiating sleep, difficulty maintaining sleep, and early morning awakening), excessive daytime sleepiness, nightmares, daytime malfunction, and lack of rest due to sleep deprivation were more prone to occur in highly stressed individuals. In addition, logistic regression analysis controlling for other adjustment factors revealed that stress coping strategies such as ‘giving up on problem-solving’, ‘enduring problems patiently’, ‘smoking’ and ‘drinking alcohol’ were positively associated with the above-mentioned sleep disorders. On the other hand, stress coping strategies such as ‘exercising’, ‘enjoying hobbies’, and ‘sharing worries’ were inversely associated with the above-mentioned sleep disorders. Conclusions Distraction-based stress coping (eg, hobbies, exercise, and optimistic thinking) was found to be preferable to problem-based stress coping in a highly stressed Japanese general population.
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El tabaco es un importante factor de riesgo para el desarrollo de enfermedades cardiovasculares y la hospitalización por este tipo de enfermedades brinda una excelente oportunidad para ayudar a dejar de fumar. Sin embargo, son pocas las intervenciones que se han llevado a cabo con estos pacientes y máxime a nivel hospitalario. El objetivo de este estudio es hacer una revisión acerca de las intervenciones para dejar de fumar realizadas con pacientes hospitalizados por enfermedad cardiovascular en la última década, con el objetivo de determinar su eficacia y conocer cuál resulta más adecuada. Para ello, se realizaron búsquedas en el registro de la Cochrane Tobacco Addiction Group así como en las bases de datos Medline, PsycINFO, PubMed y CSIC. Los 16 estudios hallados que cumplían los criterios de inclusión muestran importantes diferencias tanto en cuanto a los componentes que integran las intervenciones como en la intensidad de las mismas. Se concluye que si bien el consejo breve incrementa el abandono del tabaco en comparación con la no intervención, las intervenciones más efectivas son aquellas de mayor intensidad que tienen continuación durante al menos tres meses tras el alta hospitalaria.
Article
Purpose: Cardiac rehabilitation (CR) attendance has been associated with higher smoking cessation (SC) rates. However, for unclear reasons, smokers are consistently less likely to enroll in CR than nonsmokers, and it is uncertain what might encourage them to attend. Methods: We surveyed patients eligible for CR who were cigarette smokers at the time of hospital admission. We assessed patient intention to quit smoking, start exercising, and enroll in CR. We also measured anxiety and depression levels. Results: Of the 105 patients approached, 81 (77%) completed the survey (69% males, aged 57 ± 10 y, 72% white). Most patients reported interest in SC (80%) and attending CR (78%). Many felt that SC medications (41%), stress management programs (35%), and an exercise program with SC counseling (30%) would increase their likelihood to attend CR; however, 30% stated that they would be less likely to enroll in CR if they continued smoking following discharge. Many patients indicated high levels of anxiety (51%) and depression (27%); many desired to reduce stress following discharge (73%), with 35% stating that stress management programs would increase their likelihood to attend CR. Conclusions: Hospitalized smokers eligible for CR report significant interest in SC, attending CR, and beginning an exercise program. These patients show high levels of anxiety and depression and indicate a strong interest in stress management programs. These results suggest that messages emphasizing the role of CR in the treatment of depression, anxiety, and stress are likely to resonate with smokers, increase their enrollment in CR, and support long-term SC.
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Introduction: Smoking is the leading cause of preventable disease. Although smoking results in an acute effect of relaxation and positive mood through dopamine release, smoking is thought to increase stress symptoms such as heart rate and blood pressure from nicotine-induced effects on the HPA axis and increased cortisol. Despite the importance in understanding the mechanisms in smoking maintenance, little is known about the overall protein and physiological response to smoking. There may be multiple functions involved that if identified might help in improving methods for behavioral and pharmacological interventions. Therefore, our goal for this pilot study was to identify proteins in the saliva that change in response to an acute smoking event versus acute sham smoking event in smokers and non-smokers, respectively. Methods: We employed the iTRAQ technique followed by Mass Spectrometry to identify differentially expressed proteins in saliva of smokers and non-smokers after smoking cigarettes and sham smoking, respectively. We also validated some of the salivary proteins by ELISA or western blotting. In addition, salivary cortisol and salivary amylase (sAA) activity were measured. Results: In all, 484 salivary proteins were identified. Several proteins were elevated as well as decreased in smokers compared to non-smokers. Among these were proteins associated with stress response including fibrinogen alpha, cystatin A and sAA. Our investigation also highlights methodological considerations in study design, sampling and iTRAQ analysis. Conclusions: We suggest further investigation of other differentially expressed proteins in this study including ACBP, A2ML1, APOA4, BPIB1, BPIA2, CAH1, CAH6, CYTA, DSG1, EST1, GRP78, GSTO1, sAA, SAP, STAT, TCO1, and TGM3 that might assist in improving methods for behavioral and pharmacological interventions for smokers.
Thesis
INTRODUCTION : l’exposition professionnelle à l’amiante et l’intoxication tabagique sont 2 facteurs de risque sanitaires connus avec un retentissement psychologique négatif déjà constaté au sein d’une population de retraités du Régime Général de la Sécurité Sociale : l’impact psychologique de l’amiante était plus délétère que celui du tabac.L’OBJECTIF était de décrire la perception et le niveau de connaissances portant sur les risques sanitaires, ainsi que le retentissement psychique, de l’exposition professionnelle à l’amiante et du tabac, au sein d’une population différente au plan socio-professionnel, constituée de fonctionnaires de l’Education Nationale.MATERIEL ET METHODE : Enquête rétrospective portant sur 1088 fonctionnaires de l’Education Nationale de plus de 50 ans ayant exercé un emploi référencé comme comportant une possible exposition à l’amiante, au moyen d’un auto-questionnaire : le « Psychological Consequences Questionnaire », traduit et validé en français, permettant d’évaluer la détresse psychologique au moyen du score PCQ, considéré comme pathologique lorsqu’il est supérieur au 95ème percentile de la distribution des scores dans notre population d’étude.RESULTATS : Les fonctionnaires de l’Education Nationale ont tendance à sous-estimer leur exposition, mais à surestimer le risque amiante. Les réponses au questionnaire rapportent un PCQ pathologique chez 5.3% des sujets de l’étude. Si l’augmentation de l’âge parait augmenter le risque de PCQ pathologique, le sexe ne semble pas avoir d’impact. Les fumeurs et ex-fumeurs ont 2 à 3 fois plus de risques d’avoir un PCQ anormal que les non-fumeurs, et les fumeurs passifs constituent le groupe le plus susceptible d’avoir un PCQ pathologique. La perception d’un état de santé dégradé du fait de l’exposition à l’amiante et/ou au tabac, actuellement ou dans le futur, est également associée à un excès de risque de détresse psychologique dans les modèles multivariés.CONCLUSION : L’âge, l’état des connaissances vis-à-vis des risques sanitaires de l’amiante et du tabac, une perception péjorative des risques sanitaires liés à l’amiante, le statut tabagique lui-même, mais également un profil psychologique anxieux, semblent être des éléments à prendre en compte lors de l’information et la prise en charge des salariés ayant été exposés à l’amiante
Article
Background: Compared to nonsmokers, smokers with chronic disease are less likely to adhere to self-management recommendations for the management of their chronic conditions. Although the literature notes poor adherence trends in smokers, actual influences of adherence in these patients require further study. This study examines the health beliefs that influence self-management behaviors in smokers with chronic lung disease. Methods: This prospective, cross-sectional study surveyed patients (n = 83) seen in the pulmonary outpatient clinics of the University Medical Center of New Orleans between November 2015 and February 2016. Eligible patients included those between 40-64 years old diagnosed with asthma and/or chronic obstructive pulmonary disease (COPD). Primary measures included perceived beliefs related to the susceptibility to asthma and/or COPD becoming worse, perceived barriers to adherence, and perceived benefits to adherence. Patient characteristics under-study included smoking status, race, gender, and diagnosis. Descriptive and chi-square analyses were performed to characterize the sample. Student's t and and regression analyses were conducted to examine the relationships between perceptions, smoking status, race, gender, and diagnosis. Results: Compared to nonsmokers, smokers perceived their asthma and/or COPD becoming worse (p = 0.0023). Smokers also perceived more barriers (p < 0.0001), and fewer benefits to adherence than nonsmokers (p = 0.0021). Conclusion: The health beliefs of smokers may influence their self-management behaviors. Results of this study can inform the development of services that target smokers in order to improve adherence to self-management behaviors and health outcomes.
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A close and complex relationship between smoking and mental health problems was found. Different hypotheses have been proposed to explain these associations: 1) smoking and poor mental health may share common causes (genetic factors or environmental mechanisms); 2) for people with poor mental health smoking is a coping strategy to regulate psychiatric symptoms; 3) smokings worsen mental health. Moreover, smokers with psychiatric disorders may have more difficulty quitting and patients with mental diseases who received mental health treatment within the previous year were more likely to stop smoking than those not receiving treatment. Taylor et al. hypothesized that quitting smoking might improve rather than exacerbate mental health, because it allows to avoid multiple episodes of negative affect induced by withdrawal. With the aim to verify this hypothesis, they conducted a systematic review and meta-analysis on longitudinal studies (randomized controlled trials and cohort studies) in which the difference in change in mental health between subjects who stop smoking and subjects who continue to smoke has been explored. A total of 26 longitudinal studies evaluating anxiety, depression, mixed anxiety and depression, positive effect, psychological quality of life, and stress have been included. The study results provided enough evidence to assure that quitting smoking is associated with a reduction of depression, anxiety, and stress, with an improvement of psychological quality of life and positive affect compared with continuing to smoke. The strength of association was similar for both the general population and study enrolled populations, including those with mental health disorders. The results of this meta-analysis have direct clinical implications: the benefits for mental health could motivate physicians and patients to take into account the possibility of smoking cessation.
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Cigarette smoking is associated with some anxiety disorders, but the direction of the association between smoking and specific anxiety disorders has not been determined. To investigate the longitudinal association between cigarette smoking and anxiety disorders among adolescents and young adults. The Children in the Community Study, a prospective longitudinal investigation. Community-based sample of 688 youths (51% female) from upstate New York interviewed in the years 1985-1986, at a mean age of 16 years, and in the years 1991-1993, at a mean age of 22 years. Participant cigarette smoking and psychiatric disorders in adolescence and early adulthood, measured by age-appropriate versions of the Diagnostic Interview Schedule for Children. Heavy cigarette smoking (>/=20 cigarettes/d) during adolescence was associated with higher risk of agoraphobia (10.3% vs 1.8%; odds ratio [OR], 6.79; 95% confidence interval [CI], 1.53-30.17), generalized anxiety disorder (20.5% vs 3.71%; OR, 5.53; 95% CI, 1.84-16.66), and panic disorder (7.7% vs 0.6%; OR, 15.58; 95% CI, 2.31-105.14) during early adulthood after controlling for age, sex, difficult childhood temperament; alcohol and drug use, anxiety, and depressive disorders during adolescence; and parental smoking, educational level, and psychopathology. Anxiety disorders during adolescence were not significantly associated with chronic cigarette smoking during early adulthood. Fourteen percent and 15% of participants with and without anxiety during adolescence, respectively, smoked at least 20 cigarettes per day during early adulthood (OR, 0.88; 95% CI, 0.36-2.14). Our results suggest that cigarette smoking may increase risk of certain anxiety disorders during late adolescence and early adulthood. JAMA. 2000;284:2348-2351.
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To examine the relationship between smoking and health-related quality of life (HRQOL) and the impact of quitting smoking on changes in HRQOL among women in the two Nurses' Health Study (NHS) cohorts (n = 158,736) who were 29 to 71 years of age in 1992/1993 when they reported data on smoking status and completed the Short Form-36 version 1 (SF-36). At baseline, the SF-36 physical component scores (SF-PCS) and mental component scores (SF-MCS) were examined by smoking status (never, 56%, former, 32%, and current, 13%) within 10-year age groups. Smoking characteristics were analyzed as correlates of SF-36. Changes in smoking status and SF-PCS and SF-MCS, adjusted for comorbid disease and other covariates, were reassessed at 4-year intervals among current smokers in 1992/1993 and those who either continued smoking after 4 and 8 years or reported not smoking at both intervals. Smokers had lower HRQOL (SF-PCS and SF-MCS) as compared to never and former smokers. Current smoking, cigarettes per day and time since quitting were associated with significantly lower SF-PCS and SF-MCS. Continuing smokers and those who quit had significant declines in SF-PCS over time and significant improvements in SF-MCS at 8 years. There was minimal difference between groups, with some greater improvements in SF-MCS among those reporting non-smoking at 8 years. These findings support the lower ratings of HRQOL by smokers, but quitting alone, after an average of 21 years of smoking, did not improve HRQOL. Further study focused on the HRQOL impact of quitting smoking is needed.
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Assessed perceptions of stress prior to quitting and at 1, 3, and 6 months following quit date. Self-reported smoking status was augmented by a bogus pipeline procedure at each interview, and abstinence at 6 months was verified by carbon monoxide and saliva cotinine. The analyses provide strong evidence for a relation between changes in stress levels and changes in smoking status. Those who failed to quit smoking for more than 24 hr maintained a relatively high and consistent level of stress over the entire 6-month period. For those remaining continuously abstinent over the course of the study, stress decreased as duration of abstinence increased. Increases in stress with relapse were found across all three panel lags (prequit to 1 month, 1 to 3 months, and 3 to 6 months), and decreases in stress with quitting were found across the two lags where that comparison was possible. The possibility that the relation between smoking and stress is bidirectional is discussed as a possible interpretation of the results.
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DSM-IV lists increased anxiety as a nicotine withdrawal symptom. Increased anxiety has been reported to follow smoking cessation in most but not all studies. Indeed, there is some evidence for a reduction in anxiety, compared with precessation levels, after the first few weeks of abstinence. This study reports data from 101 smokers who attempted to stop smoking and who satisfied DSM-III-R criteria for nicotine dependence. Unlike most studies in this area, a strict criterion of lapse-free abstinence was adopted. It is argued that lapses during an attempt at cessation may underlie a transient increase in anxiety. Anxiety was measured both by a single rating typical in withdrawal studies and by the State-Trait Anxiety Inventory--State Form X. Patients were rated 2 weeks and 1 week before cessation, immediately before cessation, 24 hours after cessation, and 1, 2, 3, and 4 weeks after cessation. Seventy patients were abstinent for the 4-week follow-up period. There was no evidence of an increase in anxiety following smoking cessation. However, there was a significant decrease in anxiety from the first week of abstinence. The results weaken the view that increased anxiety is a robust and central element of the nicotine withdrawal syndrome and suggest that giving up smoking is quite rapidly followed by a reduction in anxiety that may reflect removal of an anxiogenic agent, nicotine.
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Smokers often report that cigarettes help relieve feelings of stress. However, the stress levels of adult smokers are slightly higher than those of nonsmokers, adolescent smokers report increasing levels of stress as they develop regular patterns of smoking, and smoking cessation leads to reduced stress. Far from acting as an aid for mood control, nicotine dependency seems to exacerbate stress. This is confirmed in the daily mood patterns described by smokers, with normal moods during smoking and worsening moods between cigarettes. Thus, the apparent relaxant effect of smoking only reflects the reversal of the tension and irritability that develop during nicotine depletion. Dependent smokers need nicotine to remain feeling normal. The message that tobacco use does not alleviate stress but actually increases it needs to be far more widely known. It could help those adult smokers who wish to quit and might prevent some schoolchildren from starting.
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This study builds on previous observations about a suspected causal association linking tobacco smoking with depression. With prospective data, the study sheds new light on the temporal sequencing of tobacco smoking and depressed mood in late childhood and early adolescence. The epidemiologic sample that was studied consisted of 1731 youths (aged 8-9 to 13-14 years) attending public schools in a mid-Atlantic metropolitan area, who were assessed at least twice from 1989 to 1994. A survival analysis was used to examine the temporal relationship from antecedent tobacco smoking to subsequent onset of depressed mood, as well as from antecedent depressed mood to subsequent initiation of tobacco use. Tobacco smoking signaled a modestly increased risk for the subsequent onset of depressed mood, but antecedent depressed mood was not associated with a later risk of starting to smoke tobacco cigarettes. This evidence is consistent with a possible causal link from tobacco smoking to later depressed mood in late childhood and early adolescence, but not vice versa.
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Studies of selected groups of persons with mental illness, such as those who are institutionalized or seen in mental health clinics, have reported rates of smoking to be higher than in persons without mental illness. However, recent population-based, nationally representative data are lacking. To assess rates of smoking and tobacco cessation in adults, with and without mental illness. Analysis of data on 4411 respondents aged 15 to 54 years from the National Comorbidity Survey, a nationally representative multistage probability survey conducted from 1991 to 1992. Rates of smoking and tobacco cessation according to the number and type of psychiatric diagnoses, assessed by a modified version of the Composite International Diagnostic Interview. Current smoking rates for respondents with no mental illness, lifetime mental illness, and past-month mental illness were 22.5%, 34.8%, and 41.0%, respectively. Lifetime smoking rates were 39.1%, 55.3%, and 59.0%, respectively (P<.001 for all comparisons). Smokers with any history of mental illness had a self-reported quit rate of 37.1% (P =.04), and smokers with past-month mental illness had a self-reported quit rate of 30. 5% (P<.001) compared with smokers without mental illness (42.5%). Odds ratios for current and lifetime smoking in respondents with mental illness in the past month vs respondents without mental illness, adjusted for age, sex, and region of the country, were 2.7 (95% confidence interval [CI], 2.3-3.1) and 2.7 (95% CI, 2.4-3.2), respectively. Persons with a mental disorder in the past month consumed approximately 44.3% of cigarettes smoked by this nationally representative sample. Persons with mental illness are about twice as likely to smoke as other persons but have substantial quit rates. JAMA. 2000;284:2606-2610.
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To evaluate a smoking cessation intervention that can be routinely delivered to smokers admitted with cardiac problems. Randomised controlled trial of usual care compared with intervention delivered on hospital wards by cardiac rehabilitation nurses. Inpatient wards in 17 hospitals in England. 540 smokers admitted to hospital after myocardial infarction or for cardiac bypass surgery who expressed interest in stopping smoking. Brief verbal advice and standard booklet (usual care). Intervention lasting 20-30 minutes including carbon monoxide reading, special booklet, quiz, contact with other people giving up, declaration of commitment to give up, sticker in patient's notes (intervention group). Continuous abstinence at six weeks and 12 months determined by self report and by biochemical validation at these end points. Feasibility of the intervention and delivery of its components. After six weeks 151 (59%) and 159 (60%) patients remained abstinent in the control and intervention group, respectively (P=0.84). After 12 months the figures were 102 (41%) and 94 (37%) (P=0.40). Recruitment was slow, and delivery of the intervention was inconsistent, raising concerns about the feasibility of the intervention within routine care. Patients who received the declaration of commitment component were almost twice as likely to remain abstinent than those who did not receive it (P<0.01). Low dependence on tobacco and high motivation to give up were the main independent predictors of positive outcome. Patients who had had bypass surgery were over twice as likely to return to smoking as patients who had had a myocardial infarction. Single session interventions delivered within routine care may have insufficient power to influence highly dependent smokers.
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The authors examined whether smoking cessation and relapse were associated with changes in stress, negative affect, and smoking-related beliefs. Quitters showed decreasing stress, increasing negative health beliefs about smoking, and decreasing beliefs in smoking's psychological benefits. Quitters became indistinguishable from stable nonsmokers in stress and personalized health beliefs, but quitters maintained stronger beliefs in the psychological benefits of smoking than stable nonsmokers. Relapse was not associated with increases in stress or negative affect However, relapsers increased their positive beliefs about smoking and became indistinguishable from smokers in their beliefs. For quitters, decreased stress and negative beliefs about smoking may help maintain successful cessation. However, for relapsers, declining health risk perceptions may undermine future quit attempts.
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Smoking has been found to be associated with depression. Biologic hypotheses support causation in both directions. This study examined the association between cigarette smoking and a subsequent first depression. In 1990, 2,014 adults in Norway were interviewed about their lifestyle and mental health. A 2001 reinterview by trained interviewers defined the study cohort of 1,190 participants. The cases were those who experienced a first depression whose onset was estimated to occur during the follow-up period, based on retrospective assessment by the Composite International Diagnostic Interview (International Classification of Diseases, Tenth Revision). Cox regression was used to estimate the hazard rate of depression during follow-up. Alternative explanations for a direct causal influence from smoking on subsequent depression were assessed, and a sensitivity analysis was performed. The risk of depression was four times as high for heavy smokers compared with never smokers. A dose-response relation with an increasing hazard for past smokers and for an increasing number of cigarettes smoked per day for current smokers was found. Similarly, increasing smoking time was associated with increasing risk. Failure of other plausible alternatives to explain the observed association between smoking and depression might reflect a direct causal influence of smoking on depression.
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This study investigated smokers' ratings of putative smoking motives and how these relate to smoking patterns, withdrawal symptoms, and short-term abstinence in clients attending smokers' clinics. Data were collected from 2,727 clients from two London Stop Smoking Services that offered behavioral support combined with pharmacotherapy. On a scale of 1 to 5, stress relief (M = 3.9), boredom relief (3.7), and enjoyment (3.6) were rated highest. Uses as an aid to concentration (2.9), for relief of withdrawal discomfort (2.8), and as an aid to socialization (2.8) received moderate ratings. Weight control was rated low (2.0). These ratings were found to be largely independent of each other. Ratings of enjoyment, boredom relief, improvement in concentration, and relief of withdrawal discomfort were positively correlated with daily cigarette consumption (p<.001). Ratings of smoking for withdrawal relief, enjoyment, improvement in concentration, stress relief, and boredom relief were positively correlated with nicotine dependence as measured by the Fagerström Test for Nicotine Dependence (p<.001). Strength of urges to smoke and time spent with urges to smoke in the first week of abstinence were positively correlated with smoking for withdrawal relief, to stay alert, to improve concentration, and with enjoyment of smoking (p<.01). Relapse to smoking within 4 weeks was not associated with ratings of any of the smoking motives, including enjoyment. Although correlated with a measure of dependence, no strong connection appears to exist between relapse and any of the smoking motives, suggesting that the mechanisms underlying nicotine dependence lie at a deeper level, outside the ability of smokers to be introspective regarding their motivations.
Article
The authors examined whether smoking cessation and relapse were associated with changes in stress, negative affect, and smoking-related beliefs. Quitters showed decreasing stress, increasing negative health beliefs about smoking, and decreasing beliefs in smoking's psychological benefits. Quitters became indistinguishable from stable nonsmokers in stress and personalized health beliefs, but quitters maintained stronger beliefs in the psychological benefits of smoking than stable nonsmokers. Relapse was not associated with increases in stress or negative affect. However, relapsers increased their positive beliefs about smoking and became indistinguishable from smokers in their beliefs. For quitters, decreased stress and negative beliefs about smoking may help maintain successful cessation. However, for relapsers, declining health risk perceptions may undermine future quit attempts.
Article
Context Studies of selected groups of persons with mental illness, such as those who are institutionalized or seen in mental health clinics, have reported rates of smoking to be higher than in persons without mental illness. However, recent population-based, nationally representative data are lacking.Objective To assess rates of smoking and tobacco cessation in adults, with and without mental illness.Design, Setting, and Participants Analysis of data on 4411 respondents aged 15 to 54 years from the National Comorbidity Survey, a nationally representative multistage probability survey conducted from 1991 to 1992.Main Outcome Measures Rates of smoking and tobacco cessation according to the number and type of psychiatric diagnoses, assessed by a modified version of the Composite International Diagnostic Interview.Results Current smoking rates for respondents with no mental illness, lifetime mental illness, and past-month mental illness were 22.5%, 34.8%, and 41.0%, respectively. Lifetime smoking rates were 39.1%, 55.3%, and 59.0%, respectively (P<.001 for all comparisons). Smokers with any history of mental illness had a self-reported quit rate of 37.1% (P = .04), and smokers with past-month mental illness had a self-reported quit rate of 30.5% (P<.001) compared with smokers without mental illness (42.5%). Odds ratios for current and lifetime smoking in respondents with mental illness in the past month vs respondents without mental illness, adjusted for age, sex, and region of the country, were 2.7 (95% confidence interval [CI], 2.3-3.1) and 2.7 (95% CI, 2.4-3.2), respectively. Persons with a mental disorder in the past month consumed approximately 44.3% of cigarettes smoked by this nationally representative sample.Conclusions Persons with mental illness are about twice as likely to smoke as other persons but have substantial quit rates.
Article
This article examines whether smokers who enrolled in a community-based smoking cessation program and were successful in quitting for a six-month period had better health-related quality-of-life at six months relative to those who relapsed. An observational, longitudinal design was used; the sample included 350 participants 18-65 years of age. Health-related quality-of-life was measured using a broad array of indicators of physical and mental health. Six-month outcomes were compared between successful quitters and relapsers using analysis of covariance. Those who quit for six months had better psychological well-being, cognitivefunctioning, energy/fatigue, sleep adequacy, selfesteem, sense of mastery, and worse role functioning at six months than those who continued to smoke (p values > .05). No differences were observed in physical and social functioning, pain, or current health perceptions. There were no significant differences at enrollment in health-relatedquality-of-life between those who quit subsequently and those who relapsed, thus quality-of-life measures did not predict smoking status. We conclude that smokers who quit can possibly anticipate improvements in a range of mental health outcomes within six months, which could become an additional incentive to quit. Subsequent smoking cessation studies should include health-related quality-of-life measures to determine the generalizability of these findings.
Article
A prospective design was used to determine the outcomes associated with unaided smoking cessation and the influence of stress on cessation. Heavy smokers ( N = 308) completed stress-related measures and were then recontacted at 1, 6, and 12 mo. At each follow-up, they indicated their smoking status (which was confirmed by collateral report and biochemical tests) and completed several stress-related questionnaires. Results indicate that 33% of Ss smoked continuously throughout the year, 39% quit briefly but subsequently relapsed, and 15% quit (confirmed biochemically). An additional 7% reported they had quit, but this could not be confirmed, and 6% were lost to follow-up. Compared with nonquitters, quitters reported less perceived stress, greater self-efficacy, greater use of problem solving and cognitive restructuring, and less reliance on wishful thinking, self-criticism, and social withdrawal. A model to forecast quitting was built and cross-validated. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
proposes five subtypes of abstinence effects: indefinite, offset, transient, rebound, and novel the methodology of our review, criteria for inclusion of studies and criteria for conclusions are outlined and defended the major sections of the chapter review the biochemical, physiological, behavioral, and subjective effects of abstinence / for these effects, the consistency across studies, validity, reliability, generalizability, magnitude, incidence, and time course are examined / whether the effect is best classified as an indefinite, offset, transient, or rebound effect is discussed / data on whether the effect appears to be due to nicotine deprivation are reviewed the final sections review the determinance, clinical significance, and treatment of abstinence effects (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
To determine the impact of an episode of serious cardiovascular disease on smoking behavior and to identify factors associated with smoking cessation in this setting. Prospective observational study in which smokers admitted to a coronary care unit (CCU) were followed for one year after hospital discharge to determine subsequent smoking behavior. Coronary care unit of a teaching hospital. Preadmission smoking status was assessed in all 828 patients admitted to the CCU during one year. The 310 smokers surviving to hospital discharge were followed and their smoking behaviors assessed by self-report at six and 12 months. None. Six months after discharge, 32% of survivors were not smoking; the rate of sustained cessation at one year was 25%. Smokers with a new diagnosis of coronary heart disease (CHD) made during hospitalization had the highest cessation rate (53% vs. 31%, p = 0.01). On multivariate analysis, smoking cessation was more likely if patients were discharged with a diagnosis of CHD, had no prior history of CHD, were lighter smokers (less than 1 pack/day), and had congestive heart failure during hospitalization. Among smokers admitted because of suspected myocardial infarction (MI), cessation was more likely if the diagnosis was CHD than if it was noncoronary (37% vs. 19%, p less than 0.05), but a diagnosis of MI led to no more smoking cessation than did coronary insufficiency. Hospitalization in a CCU is a stimulus to long-term smoking cessation, especially for lighter smokers and those with a new diagnosis of CHD. Admission to a CCU may represent a time when smoking habits are particularly susceptible to intervention. Smoking cessation in this setting should improve patient outcomes because cessation reduces cardiovascular mortality, even when quitting occurs after the onset of CHD.
Article
Numerous investigators have examined the role of negative affective states and affect regulation in the initiation and development of cigarette smoking behavior, smoking cessation, and relapse prevention. Affect regulation refers to any attempt to alleviate negative mood states by means of pharmacologic-, cognitive-, behavioral- or environmental-change methods. The psychological construct/process of affect regulation is examined in relation to (1) the initiation, development, and maintenance of the cigarette smoking habit; (2) the process of quitting smoking; and (3) the long-term maintenance of smoking abstinence versus relapse. Various psychosocial factors and physiological mechanisms are explored that have been hypothesized to be links between negative mood states, nicotine addiction, and smoking cessation. Implications for smoking cessation treatment are discussed in the areas of (1) the use of pharmacologic agents, such as clonidine, in the reduction of nicotine withdrawal symptoms; (2) nicotine replacement therapy; and (3) skills-training approaches to smoking cessation and relapse prevention.
Article
This review summarizes the findings from a series of four published studies into the relationship between cigarette smoking and stress. In each study, feelings of anxiety/stress were significantly lower post-smoking than pre-smoking (p < 0.001). However, while moods improved immediately after smoking, mood impairments occurred between cigarettes. This repetitive cycle of mood reversals provides a clear rationale for repetitive/addictive cigarette use. The degree of stress modulation was significantly related to the sedative subscale of the Smoking Motivation Questionnaire (p < 0.01). However, high SMQ sedative subjects reported above-average stress prior to smoking, rather than below-average stress after smoking. Thus stress modulation represented mainly the relief of adverse moods, rather than the attainment of beneficial moods. Deprived smokers reported a diurnal pattern of increasing stress, confirming the deleterious effects of nicotine deprivation. These studies demonstrated the importance of mood control as a motive for smoking. They indicate that smokers gain little real advantage from cigarettes, but smoke mainly to forstall nicotine depletion. The deleterious mood effects of acute nicotine withdrawal also helps explain why, when smokers quit smoking, they experience reduced levels of daily stress.
Article
Recent epidemiologic studies have revealed that comorbidity of psychiatric disorders is far more pervasive than previously suspected. Strong associations have been reported between specific substance use disorders and between any mental disorder and any substance use disorder. This report focuses on comorbidity of nicotine dependence, a substance use disorder on which little epidemiologic information is available. Data come from an epidemiologic study of approximately 1000 young adults in southeast Michigan, in which the NIMH-DIS, revised according to DSM-III-R, was used. Lifetime prevalence of nicotine dependence was 20%. Males and females with nicotine dependence had increased odds for alcohol and illicit drug disorders, major depression, and anxiety disorders, compared with nondependent smokers and nonsmokers combined. Major depression and any anxiety disorder were associated specifically with nicotine dependence. Increased odds for alcohol or illicit drug disorders were observed also in nondependent smokers, compared to nonsmokers. History of early conduct problems increased the odds for nicotine dependence among smokers. Potential mechanisms in the comorbidity of nicotine dependence are discussed.
Article
We examined prospectively the association between nicotine dependence and major depression (MDD). The following questions were addressed: (1) Are smokers with a history of MDD at increased risk for progression to nicotine dependence and more severe levels of dependence? (2) Are persons with a history of nicotine dependence at increased risk for MDD? A sample of 995 young adults were interviewed in 1989 and reinterviewed in 1990, 14 months later. The revised National Institute of Mental Health-Diagnostic Interview Schedule was used to ascertain DSM-III-R nicotine dependence and other substance use and psychiatric disorders. A history of MDD increased the risk for progression to nicotine dependence or more severe levels of dependence (odds ratio, 2.06; 95% confidence interval, 1.21 to 3.49). In addition, persons with a history of nicotine dependence had a higher rate of first-incidence MDD during the follow-up period than persons with no history of nicotine dependence (7.5% vs 3.2%; odds ratio, 2.45; 95% confidence interval, 1.17 to 5.15). The prospective data suggest that the association between nicotine dependence and MDD, observed previously in cross-sectional studies, might be either causal, with influences flowing in both directions, or, more probably, noncausal, reflecting the effects of common factors that predispose to both disorders.
Article
The massive health problem associated with cigarette smoking is exacerbated by the addictive properties of tobacco smoke and the limited success of current approaches to cessation of smoking. Yet little is known about the neuropharmacological actions of cigarette smoke that contribute to smoking behaviour, or why smoking is so prevalent in psychiatric disorders and is associated with a decreased risk of Parkinson's disease. Here we report that brains of living smokers show a 40% decrease in the level of monoamine oxidase B (MAO B; EC 1.4.3.4) relative to non-smokers or former smokers. MAO B is involved in the breakdown of dopamine, a neurotransmitter implicated in reinforcing and motivating behaviours as well as movement. MAO B inhibition is therefore associated with enhanced activity of dopamine, as well as with decreased production of hydrogen peroxide, a source of reactive oxygen species. We propose that reduction of MAO B activity may synergize with nicotine to produce the diverse behavioural and epidemiological effects of smoking.
Article
To examine the relationship between cigarette smoking and self-reported physical and mental functional status. Cross-sectional survey of 837 patients visiting 2 family-practice centers. Patients completed a self-administered survey about functional status, tobacco use, and demographic characteristics while waiting to be called back for their appointments. An inner-city family practice clinic in Richmond, Virginia, and a more affluent suburban practice outside Washington, DC. Physical and mental functional status, as measured by the SF-36 (Medical Outcomes Trust, Boston, MA); current and former cigarette use; and demographic variables (age, gender, education, income). Among current smokers, self-reported functional status scores were significantly lower than those of nonsmokers in all SF-36 domains (p < or = 0.02), a pattern that was more dramatic for mental functional status domains (social function, vitality, emotional role limitations, mental health). In several SF-36 domains, a dose-response relationship between smoking and functional status was noted. After multivariate adjustment for demographic confounders and practice site, the statistical significance of these differences diminished considerably, but it remained significant for certain domains and for the overall difference across all domains (MANCOVA p = 0.017). Current smokers report lower functional status than nonsmokers, in physical and especially in mental domains. The meaning of this cross-sectional relationship is unclear without further longitudinal study. Smoking may be associated with other variables that have a causal role.
Article
Previous studies of smoking habits of schizophrenic patients have found rates as high as 88%. The authors report the smoking habits of all known schizophrenic patients within a discrete geographical area and compare them with the smoking habits of a general population sample. All known schizophrenic patients in Nithsdale in South-West Scotland (N = 168) were invited to complete a questionnaire on smoking habits. Also assessed were mental state, drug-related side effects, and premorbid childhood personality and social adjustment. One hundred thirty-five of the 168 patients returned the questionnaires. The rate of smoking among the patients was 58% (N = 78), compared with 28% in the general population. Sixty-eight percent of the patients who smoked (N = 53) had 25 or more cigarettes per day. The mean age at starting smoking was 17 years in both patients and normal subjects. Ninety percent of the patients who smoked (N = 70) started smoking before the onset of schizophrenia. Patients who smoked were younger than nonsmokers, and more of them were male. They had had more hospitalizations, and more were in contact with psychiatric services. More were receiving intramuscular antipsychotic medication. Smokers had poorer childhood social adjustment. Among the female patients, there was a positive correlation between age at starting smoking and age at onset of schizophrenia. The rate of smoking and level of nicotine addiction are greater in schizophrenic patients than in the general population. Smoking may be a marker for the neurodevelopmental form of the illness and may be another environmental risk factor for schizophrenia in vulnerable individuals.
Article
Comments on the article by A. C. Parrott (see record 1999-11644-002) regarding the link between cigarette smoking and stress. Parrott was correct in claiming that nicotine provides relief from the subjective distress evoked by withdrawal, as ample evidence supports this contention. However, his assertions that (1) smoking has no direct effect on affective distress and (2) smoking actually causes stress must be questioned. Identifying the contexts in which smoking exerts its effects on behavior, cognition, and emotion is crucial to furthering the understanding of why nicotine is so reinforcing. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Knowledge of the impact of smoking cessation on health-related quality of life may be important in encouraging smokers to quit. We determined whether the difference in quality of life between ex- and current smokers is influenced by amount of smoking or time since quitting. Data were collected within a cross-sectional study among a random sample of the general population in The Netherlands. Health-related quality of life was measured with the RAND-36 questionnaire (adapted from SF-36). Smoking behavior was assessed with a self-administered questionnaire. Adjusted differences in quality of life scores between ex- and current smokers were tested with multivariate analysis of variance, among 9,660 men and women aged 20-59 years, without history of tobacco-related chronic diseases. Ex-smokers reported significantly higher quality of life scores than current smokers. This was more pronounced for mental health, especially for role functioning limitations due to emotional problems (difference 6.5 points; P < 0.0001), than for physical health dimensions. Differences were generally larger between ex- and current heavy smokers than between ex- and current light or moderate smokers (P trend <0.05 when ex-smokers had quit <5 or > or =10 years ago). No significant trend was observed with time since quitting. Generally, the higher the amount of smoking, the higher were quality of life differences between ex- and current smokers.
Article
In an open study, we determined whether there were sex differences in the mood ratings of non-deprived light smokers and nonsmokers under baseline conditions and after completing a battery of cognitive tests that were mildly stressful. Male and female students who were light smokers (5-12 cigarettes a day) were tested immediately after smoking their usual cigarette, at a time that they normally smoked. They were compared with a group of male and female students who were nonsmokers and did not differ on age, IQ, personality measures, anxiety or depression. Compared with the nonsmokers, both male and female smokers felt overall significantly more discontented, troubled, tense, quarrelsome, furious, impatient, hostile, annoyed and disgusted and experienced greater dizziness. The performance of distracting cognitive tasks did not reveal anxiolytic effects of smoking, and after performance of these tasks, both smokers and nonsmokers became more discontented and anxious. In addition, after the cognitive testing, both male and female smokers showed greater increases than nonsmokers in feeling spiteful, rebellious, incompetent and in sweating, suggesting that they experienced greater mood changes in response to cognitive stress. There were no overall differences between the smokers and nonsmokers in the performance of divided or sustained attention tasks or in episodic memory. It is unlikely that either nicotine withdrawal or differences in cognitive performance could account for the greater anxiety, discontent and aggressive mood that was found in smokers.
Article
Recent reports suggest that nicotine withdrawal symptoms are common among adolescents after a few weeks of intermittent tobacco use. No current model of nicotine dependence had predicted the rapid development of symptoms of dependence and withdrawal before the development of tolerance. We present a model that integrates neuroscience with clinical observations regarding how nicotine dependence develops, progresses, and resolves in humans. The central tenet of this sensitization-homeostasis model is that nicotine's dependence liability derives from its ability to stimulate neural pathways responsible for the suppression of craving. As a result of sensitization, the craving suppression produced by nicotine is magnified to superphysiological levels. The overinhibition of neurons responsible for craving initiates compensatory homeostatic measures that stimulate the craving pathways and result in craving when nicotine is absent. Separate homeostatic mechanisms are responsible for craving, withdrawal, and tolerance. The sensitization-homeostasis model is unique in its attribution of dependence to craving suppression, its attention to the temporal relationships among clinical features of nicotine dependence, and its extensive integration of clinical observations and basic science. It provides a framework for theory-based research.
Article
This study evaluated change in health status as a function of change in smoking status among patients treated clinically for nicotine dependence by comparing overall perceived health status of patients who abstained from cigarettes for 1 year versus those who smoked continuously for 1 year. Patients from the Mayo Clinic Nicotine Dependence Center completed a quality-of-life questionnaire (SF-36) following their consultation for nicotine dependence (baseline). At 1 year post-intervention, patients were mailed a follow-up survey that included the SF-36 and items assessing interval smoking history. Study patients included those who self-reported continuous smoking (n=60) and those reporting continuous smoking abstinence for the entire follow-up year (n=146). Data from SF-36 scales at 1 year were analysed using analysis of covariance with baseline scale scores serving as covariates along with baseline characteristics that differed significantly between groups. Compared with those who continued to smoke, patients who were continuously abstinent from smoking for the entire year had more improvement in perceived health status for the SF-36 mental composite scale (P=0.009) and for the SF-36 subscales for role limitations (P<0.001 and P=0.017 for emotional and physical role limitations, respectively), social functioning (P=0.010) and general health (P=0.013). Smokers treated for nicotine dependence who stop smoking for a year report more improvement in-quality-of-life compared with those who continue to smoke.
Article
To evaluate whether smoking cessation after a coronary event improves quality of life, and to assess whether quality of life is a predictor of smoking cessation. Health-related quality of life at baseline and at 12 months follow up were measured in a randomised smoking cessation trial of 240 smokers aged under 76 years admitted for myocardial infarction, unstable angina or coronary bypass surgery. At 12 months follow up 101 had managed to give up smoking (quitters), and 117 were smokers (sustained smokers). The quitters and sustained smokers had similar improvements in all quality of life domains from baseline to 12 months follow up. Further, after adjustment for differences in baseline characteristics, the quality of life was not significantly different in the quitters compared to the sustained smokers neither at baseline nor at 12 months follow up. Smoking cessation did not improve quality of life compared to sustained smoking after a coronary event in a 12 month follow up. Quality of life was not a significant predictor of smoking cessation.
Pharmacological and psychological determi-nants of smoking Smoking Behav-iour, Physiological and Pyschological Influences. Edinburgh: Churchill-Livingstone
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Perceived stress, quitting smoking, and smoking relapse
  • Cohen
Stress modulation over the day in cigarette smokers
  • Parrott