Predictors of outcome in a general practitioner intervention against smoking

doi:10.1016/0091-7435(86)90044-7

Preventive Medicine

Volume 15, Issue 3, March 1986, Pages 244-253

https://doi.org/10.1016/0091-7435(86)90044-7 Get rights and content

Abstract

Analysis of baseline population characteristics in a large-scale (N = 1,328), controlled trial of general practitioner intervention against smoking (including advice and advice plus nicotine gum groups) revealed significant associations between the probability of abstinence at 4 months and sex, longest previous abstinence, dependence, motivation to quit smoking, and cigarette consumption. Women did less well overall, and dependence had a greater negative relationship to outcome among women than among men. The positive association of motivation was greater for higher levels of cigarette consumption. In the nicotine gum group, the negative dependence relationship was smaller than that in the other two groups (advice and control). Longest previous abstinence had a curvilinear relationship to outcome, the positive association diminishing as length of abstinence increased. Notwithstanding the above interactions, the gum offer was universally beneficial, except at the lowest levels of dependence, where it had little effect.

References (12)

K. Fagerstrom
Effects of nicotine chewing gum and follow-up appointments in physician-based smoking cessation
Prev. Med.
(1984)
J.K. Ockene et al.
Relationship of psychosocial factors to smoking behavior change in an intervention program
Prev. Med.
(1982)
L.L. Pederson et al.
Multivariate statistical models for predicting change in smoking behavior following physican advice to quit smoking
Prev. Med.
(1982)
R.A. Eisinger
Psychosocial predictors of smoking recidivism
J. Health Soc. Behav.
(1971)
F.E. Harrell
The LOGIST procedure
W.A. Hunt et al.
Relapse rates in addiction programs
J. Clin. Psychol.
(1971)

There are more references available in the full text version of this article.

Cited by (57)

Sex differences in the reward deficit and somatic signs associated with precipitated nicotine withdrawal in rats
2019, Neuropharmacology
Citation Excerpt :
People who quit smoking experience an intense craving for nicotine, anhedonia, cognitive impairment, and increased anxiety (Cook et al., 2015, 2017). There is evidence that female smokers are more likely to relapse than male smokers (Jackson et al., 1986; Smith et al., 2016; Tunstall et al., 1985). Nicotine addiction is a complex disorder, and many factors play a role in smoking and relapse.
Female smokers are more likely to relapse than male smokers, but little is known about sex differences in nicotine withdrawal. Therefore, male and female rats were prepared with minipumps that contained nicotine or saline and sex differences in precipitated and spontaneous nicotine withdrawal were investigated. The intracranial self-stimulation (ICSS) procedure was used to assess mood states. Elevations in brain reward thresholds reflect a deficit in reward function. Anxiety-like behavior was investigated after the acute nicotine withdrawal phase in a large open field and the elevated plus maze test. The nicotinic receptor antagonist mecamylamine elevated the brain reward thresholds of the nicotine-treated rats but did not affect those of the saline-treated control rats. A low dose of mecamylamine elevated the brain reward thresholds of the nicotine-treated male rats but not those of the females. Mecamylamine also precipitated more somatic withdrawal signs in the nicotine-treated male than female rats. Minipump removal elevated the brain reward thresholds of the nicotine-treated rats for about 36 h but did not affect those of the saline-treated rats. There was no sex difference in the reward deficit during spontaneous nicotine withdrawal. In addition, the nicotine-treated male and female rats did not display increased anxiety-like behavior three to four days after minipump removal. In conclusion, these studies suggest that relatively low doses of a nicotinic receptor antagonist induce a greater reward deficit and more somatic withdrawal signs in male than female rats, but there is no sex difference in the reward deficit during spontaneous withdrawal.
Smoking cessation counseling center in a French hospital: Effectiveness at one year and predictors of outcome
2006, Presse Medicale
Évaluer l’efficacité à 1 an et les facteurs prédictifs d’échec d’une consultation hospitalière d’aide au sevrage tabagique.
Cette étude prospective descriptive médicopsychologique a porté sur les fumeurs venant en consultation pendant 1 an. Les schizophrènes et les personnes qui ne sont venues qu’à la première consultation ont été exclus de l’étude. Les moyens thérapeutiques utilisés étaient ceux recommandés par la conférence de consensus de 1998: substituts nicotiniques ou bupropion à libération prolongée en fonction du niveau de dépendance nicotinique, thérapie comportementale et cognitive adaptée au tabagisme dans tous les cas, prescription préalable au sevrage d’un inhibiteur de la recapture de la sérotonine (IRS) en cas de trouble anxieux et/ou d’épisode dépressif majeur. L’évaluation du sevrage était réalisée d’après les déclarations des patients à 3 mois, 6 mois et 1 an.
Sur les 99 fumeurs ayant consulté, 38 ont été exclus et 61 ont pu être retenus pour l’analyse. Le maintien du sevrage à 1 an a été obtenu chez 18 d’entre eux (29,5 %). Les 43 rechutes sont survenues au cours des 3 premiers mois pour 27 d’entre elles (63 %). En analyse multivariée, seuls le sexe féminin (p=0,0173) et un suivi prématurément interrompu (p=0,0023) étaient significativement associés au risque de rechute à 1 an.
L’étude a confirmé l’intérêt d’un soutien médical spécialisé, prolongé pendant 1 an, et souligné les difficultés du sevrage chez les femmes, qui appelle une approche différentielle qui reste à définir. Les autres facteurs prédictifs classiques d’échec n’ont pas été observés, possiblement en raison de la prescription large des IRS en cas de comorbidité anxiodépressive et/ou des limites statistiques liées à la taille de la population étudiée.
To assess the effectiveness at 1 year of a hospital clinic providing individual management of persons seeking to stop smoking and the factors predictive of failure.
This prospective descriptive study included smokers seeking assistance at this hospital clinic over a 1-year period. This analysis excludes persons with schizophrenia and those who came only to a first consultation. Treatment methods were those recommended by the 1998 consensus conference: nicotine substitutes or slow-release bupropion, depending on the level of nicotine dependence, cognitive-behavioral therapy appropriate for smoking in all cases, and the prescription before cessation of a selective serotonin re-uptake inhibitor (SSRI) for patients with anxiety or depressive disorders. Assessment was based on patients’ self-report at 3 months, 6 months and 1 year.
Of 99 smokers who came for at least one consultation, 38 were excluded and 61 were considered in the analysis. At one year, 18 patients (29.5%) were still not smoking. Of the 43 patients who resumed smoking, 27 (63%) did so during the first three months after cessation. According to the multivariate analysis, only female sex (p=0.0173) and early end to follow-up (p=0.0023) were significantly associated with the risk of relapse at 1 year.
The study confirmed the usefulness of specialized medical support over a one-year period and highlighted the difficulties of smoking cessation for women, who appear to need a new not yet invented approach. The other standard factors predictive of failure were not observed, possibly because of either the broad prescription of SSRIs in cases of anxiety- or depression-related comorbidity or the statistical limitations associated with the population size.
Death, depression and 'defensive expansion': Closing down smoking as an issue for discussion in GP consultations
2006, Social Science and Medicine
This paper examines routine primary care consultations in the UK where smoking is discussed using data from a larger study of the factors influencing discussion of smoking between general practitioners (GPs) and patients. In this study, consultations have been analysed with a focus on the termination of discussion about smoking, using an approach that is informed by the conversation analytic (CA) literature on professional/client interaction. In interviews from the previous larger study, GPs suggested two main reasons for not pursuing discussion of smoking in consultations. One reason was an overarching fear of damaging the GP/patient relationship. The second reason related to clinical judgement, where it was feared that an attempt to stop smoking might exacerbate a patient's existing condition, particularly their mental health. This paper suggests that, while this latter scenario of clinical judgement is borne out by the consultation data, there are two more subtle patient behaviours which are associated with GPs abandoning further discussion of smoking: patients’ ‘troubles telling’, where the issue of smoking is de-emphasised in the face of other ‘troubles’, and ‘defensive expansion’, where the patient over-emphasises deficiencies to curtail discussion. Greater awareness of the situations in which doctors end discussion of smoking will help GPs to develop ideas for alternative approaches in these circumstances which could result in more meaningful, effective engagement between doctors and their patients who smoke when smoking is discussed.
Using content analysis of video-recorded consultations to identify smokers' 'readiness' and 'resistance' towards stopping smoking
2000, Patient Education and Counseling
Although physicians’ brief advice against smoking is effective in helping smokers to stop, very little is known about the process of counseling smokers. We describe the development of a coding system for describing smokers’ motivation to stop smoking as judged by their behaviour when discussing smoking with their family physician. We analysed video-recordings of consultations between 47 self-reported smokers and 29 family physicians where smoking was discussed. By a process of observing recordings, reading transcripts and discussion, we developed a coding system for describing smokers’ levels of motivation to stop smoking. This consists of four behaviours thought to indicate “readiness” (higher motivation to stop) and four “resistance” (lower motivation to stop). Interobserver reliability between two observers was good (Kappa=0.71 for readiness, 0.73 for resistance behaviours). We discuss the relevance of our descriptions for clinicians and the possibility of developing this work further to enable systematic research into doctor–patient interactions where smokers are counseled to stop.
Predictors of smoking cessation following physicians' counseling
1998, Preventive Medicine
Background. The purpose of this study was, to identify predictors of quitting following general practitioners' (GP) anti-smoking counseling.
Methods. We studied determinants (characterized following the Precede framework) of successful quitting (1 year sustained abstinence, biochemically confirmed at 6- and 12-month follow-up) among 861 smokers randomized to the intervention groups based on repeated counseling (RC), RC+spirometric testing, and RC+nicotine gum, in a smoking cessation trial carried out in Turin, Italy.
Results. GPs' intervention worked best for male (OR= 2.30; 95%CI, 1.13–4.52) and married (OR=3.63; 95%CI, 1.37–9.59) smokers, for smokers who had maintained abstinence for at least 1 month in the past (OR=6.78; 95%CI, 1.56–29.52) or at their first quit attempt (OR= 10.91; 95%CI, 2.37–50.13), and for those who spontaneously reduced their coffee consumption (OR=3.30; 95%CI, 1.59–6.82); heavy smokers (>=20 cig/day OR= 0.48; 95%CI, 0.24=n0.93) and those living with other smokers (>=1 smokers in the household: OR=0.44; 95%CI, 0.22–n0.90) were less likely to give up. Previous anti-smoking advice by the GP represented a strong barrier to success for healthy smokers (OR=0.19; 95%CI, 0.07–0.52), but not for those reporting symptoms of shortness of breath (OR=0.63; 95%CI, 0.39–9.20). There were no interactions between predictors and treatment conditions.
Conclusions. Assessment of factors influencing quitting would allow GPs to tailor their message to address existing barriers and to help patients utilize their resources for change.
Health habits and illness behaviour: Social factors in patient self-management
1998, Respiratory Medicine

View all citing articles on Scopus

^☆: Supported by the A. B. Leo Research Foundation, Sweden, and the Medical Research Council, England.

View full text

General articlePredictors of outcome in a general practitioner intervention against smoking☆

Abstract

Prev. Med.

Prev. Med.

Prev. Med.

Psychosocial predictors of smoking recidivism

J. Health Soc. Behav.

The LOGIST procedure

Relapse rates in addiction programs

J. Clin. Psychol.

General article
Predictors of outcome in a general practitioner intervention against smoking☆