Gender and Determinants of Smoking Cessation: A Longitudinal Study

doi:10.1006/pmed.1999.0510

Preventive Medicine

Volume 29, Issue 1, July 1999, Pages 57-62

https://doi.org/10.1006/pmed.1999.0510 Get rights and content

Abstract

Background. The less favorable trend in smoking prevalence in women compared to men may be due to lower cessation rates. We analyzed determinants of spontaneous smoking cessation with particular reference to gender differences.

Methods. Data on smoking were collected by questionnaire in three samples of the adult population, examined for the first time at intervals between 1976 and 1984. In total 11,802 (59%) subjects were smokers, and 9085 of them attended a reexamination after 5 years. Ten to 16 years later 6053 were examined once again. Logistic regression was performed to study the relation of determinants to having quit after 5 and 10–16 years.

Results. The prevalence of quitting was 12 and 22% at first and second follow-up, respectively. At both reexaminations, quitting smoking was positively associated with male sex and cigar smoking and negatively associated with the amount of tobacco smoked, inhalation, and alcohol consumption. Furthermore, in women, smoking cessation was positively associated with level of education and body mass index (BMI). Smoking cessation was not affected by cohabitation status, leisure activity, or bronchitis symptoms.

Conclusions. Smoking cessation initiatives should be targeted at heavy cigarette smokers, and at women, in particular the lean and poorly educated.

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The effect of alcohol use on smoking cessation: A systematic review
2023, Alcohol
Only a small minority of all attempts to stop smoking are successful, especially among smokers who are heavy drinkers and those with an alcohol use disorder. The current systematic review focuses on the negative effects of alcohol use, either before or during attempts to quit smoking, on the success rate of these attempt(s) in alcohol-drinking tobacco smokers. We conducted a systematic review of naturalistic and experimental studies, which included at least 40 tobacco smokers with a recorded drinking status (non-drinking, heavy drinking, alcohol use disorder) and a clearly documented change in alcohol consumption. We could not conduct a meta-analysis and, thus, used consistency across studies to draw conclusions. The evidence presented here shows that alcohol use is associated with lower rates of success in quitting smoking in 20 out of 27 studies. This includes both lapses and relapses. Similarly, in 19 out of 20 long-term follow-up studies, the duration of smoking abstinence was shorter among persons with higher alcohol consumption. Finally, 12 out of 13 experimental studies showed that exposure of smokers to alcohol cues or to drinking of alcohol induce a strong propensity to smoke. It is, therefore, recommended for smokers who drink alcohol and who intend to quit smoking to use an integrated approach, i.e., to stop or substantially reduce their alcohol consumption before and/or during their attempt to quit smoking.
Smoking characteristics and alcohol use among women in treatment for alcohol use disorder
2020, Addictive Behaviors
Understanding the association between smoking and alcohol use among women may help inform the delivery of targeted interventions to address both of these health behaviors.
This study analyzed data from N = 138 women enrolled in a randomized clinical trial comparing female-specific individual versus group cognitive-behavior therapy for alcohol use disorder (AUD). We assessed cigarette use patterns, participants’ interest in quitting smoking and motivation to quit smoking during treatment for AUD, and examined the relationship between smoking and alcohol use before and during alcohol treatment.
Over a third of the sample reported smoking cigarettes at baseline (N = 47, 34.1%), with the majority of smokers reporting daily cigarette use. At baseline, those who smoked reported a high interest in quitting smoking M = 7.8 out of 10 (SD = 2.7), although most believed they should quit smoking only after achieving some success in quitting drinking (50.0%). However, participants who smoked cigarettes (compared to non-smokers) reported more alcohol abuse and dependence symptoms (p = .001), lower rates of completing the alcohol treatment (p = .03), attended significantly fewer treatment sessions (p = .008), and consumed significantly more drinks per day on average both at baseline (p = .002) and during the treatment period (p = .04).
Findings suggest that women with AUD who also smoke cigarettes have greater difficulty engaging in or responding to treatment for their alcohol use. However, these participants reported high interest in quitting smoking but low perceived readiness during AUD treatment, suggesting that motivational interventions should be considered that could take advantage of the opportunity to treat women for both of these co-occurring behaviors while in treatment.
Predictors of reduced smoking quantity among recovering alcohol dependent men in a smoking cessation trial
2018, Addictive Behaviors
Citation Excerpt :
Among smokers without AD, those with less severe nicotine dependence typically have greater quit rates (Caponnetto & Polosa, 2008; Carlson, Taenzer, Koopmans, & Bultz, 2000; Dale et al., 2001; Murray et al., 2000). Severity of AD may also predict smoking outcomes, as lower levels of drinking and alcohol-related problems have predicted better smoking cessation in smokers without AD (Augustson et al., 2008; Hughes & Kalman, 2006; Hyland et al., 2004; Osler, Prescott, Godtfredsen, Hein, & Schnohr, 1999). Among smokers with alcohol or substance use disorders, severity of nicotine dependence has predicted smoking cessation in some studies (Rohsenow et al., 2015) but not others (Rohsenow, Martin, Tidey, Monti, & Colby, 2013), as discussed in a prior review (Heffner, Barrett, & Anthenelli, 2007).
Adults with alcohol dependence (AD) have exceptionally high smoking rates and poor smoking cessation outcomes. Discovery of factors that predict reduced smoking among AD smokers may help improve treatment. This study examined baseline predictors of smoking quantity among AD smokers in a pharmacotherapy trial for smoking cessation.
The sample includes male, AD smokers (N = 129) with 1–32 months of alcohol abstinence who participated in a 12-week trial of medication (topiramate vs. placebo) and adjunct counseling with 6 months of follow-up. Baseline measures of nicotine dependence, AD severity, psychopathology, motivation to quit smoking, and smoking-related cognitions were used to predict smoking quantity (cigarettes per day) at post-treatment and follow-up.
Overall, the sample had statistically significant reductions in smoking quantity. Greater nicotine dependence (Incidence rate ratios (IRRs) = 0.82–0.90), motivation to quit (IRRs = 0.65–0.85), and intrinsic reasons for quitting (IRRs = 0.96–0.98) predicted fewer cigarettes/day. Conversely, greater lifetime AD severity (IRR = 1.02), depression severity (IRRs = 1.05–1.07), impulsivity (IRRs = 1.01–1.03), weight-control expectancies (IRRs = 1.10–1.15), and childhood sexual abuse (IRRs = 1.03–1.07) predicted more cigarettes/day.
Smokers with AD can achieve large reductions in smoking quantity during treatment, and factors that predict smoking outcomes in the general population also predict greater smoking reductions in AD smokers. Treatment providers can use severity of nicotine dependence and AD, motivation to quit, smoking-related cognitions, and severity of depression to guide treatment and improve outcomes among AD smokers.
Sex differences in the association between countries’ smoking prevalence and happiness ratings
2018, Public Health
Citation Excerpt :
For instance, countries with more equal measurements of gender empowerment do tend to have more similar smoking rates between men and women.24 Moreover research has shown that men, on average, are more likely to succeed at quitting smoking,40–42 men respond differently to nicotine replacement treatment,43 and women are sometimes less likely to receive cessation assistance such as pharmacotherapy in the healthcare setting.44,45 A societal factor such as country-level happiness might interact with how men and women respond to smoking cessation assistance and how they seek support for quit attempts.
To examine the cross-sectional relationship between measures of countries' happiness and countries' prevalence of tobacco smoking. Since smoking prevalence differs widely based on sex in some countries and is similar in other countries, it was examined if there was a sex difference in the relationship between smoking prevalence and country-specific happiness ratings.
Ecological study design.
Countries' age-standardized prevalence estimates of smoking any tobacco product among persons aged 15 years and older (%) for 2015 were obtained from the World Health Organization (WHO) Global Health Observatory. Country-specific scores from the World Happiness Report 2016 Update Ranking of Happiness (2013–15) and the 2015 Gallup Positive Experience Index were matched and correlated to 2015 WHO estimates of tobacco smoking prevalence for males and females. The difference between male and female age-standardized smoking prevalence estimates in each country was calculated by subtracting female prevalence from male prevalence and was then correlated to countries' World Happiness Report scores. The analyses did not control for potential confounders.
The association between male age-standardized smoking prevalence estimates and countries' World Happiness Report scores was inversely correlated [r(104) = −0.22, P = 0.03], whereas the association between female age-standardized smoking prevalence estimates and countries' World Happiness Report scores was positively correlated [r(104) = 0.48, P = 0.00]. An inverse correlation was found between the difference in male and female smoking prevalence estimates and countries' World Happiness Report scores [r(104) = −0.50, P = 0.00]. The association between countries' male age-standardized smoking prevalence estimates and the Positive Experience Index scores was inversely correlated [r(99) = −0.37, P = 0.00], whereas the female age-standardized smoking prevalence estimates in countries were not significantly associated with Positive Experience Index scores [r(99) = −0.03, P = 0.75].
There are distinct sex differences between the amounts of happiness measured in countries and male and female smoking rates. Greater inequality in age-standardized smoking prevalence estimates between males and females is associated with lower amounts of happiness as measured by the World Happiness Report. These findings can be applied to population-based strategies aimed at reducing national smoking rates in men and women.
Predictors of smoking cessation: A longitudinal study in a large cohort of smokers
2017, Respiratory Medicine
Citation Excerpt :
Motivational factors and a past quit attempt were predictive for making quit attempts, but not for their success. In separate prospective studies not included in the systematic review, older age, male gender, higher socioeconomic status, lower alcohol intake, impaired lung function, a strong desire to quit smoking, lower nicotine dependence, and no other smokers in the household have been reported to predict smoking cessation in the general population [8–15]. Apart from impaired lung function, it seems reasonable to assume that individuals with known respiratory disease or cardiovascular risk factors/disease would be more concerned about their health and would therefore be more eager to stop smoking.
There are few studies on predictors of smoking cessation in general populations. We studied the smoking cessation rate in relation to several potential predictors, with special focus on respiratory and cardiovascular disease.
Smokers (n = 4636) from seven centres in Northern Europe, born between 1945 and 1973, who answered a questionnaire in 1999–2001 (the RHINE study) were followed up with a new questionnaire in 2010–2012. Altogether 2564 answered the questionnaire and provided complete data on smoking. Cox regression analyses were performed to calculate hazard ratios (HRs).
A total of 999 subjects (39%) stopped smoking during the study period. The smoking cessation rate was 44.9/1000 person-years. Smoking cessation was more common with increasing age, higher education and fewer years of smoking. Asthma, wheeze, hay fever, chronic bronchitis, diabetes and hypertension did not significantly predict smoking cessation, but smokers hospitalized for ischaemic heart disease during the study period were more prone to stopping smoking (HR 3.75 [2.62–5.37]).
Successful smoking cessation is common in middle-aged smokers, and is associated with few smoking years and higher education. A diagnosis of respiratory disease does not appear to motivate people to quit smoking, nor do known cardiovascular risk factors; however, an acute episode of ischaemic heart disease encouraged smoking cessation in our study population.
The effect of interactivity on smokers' intention to quit: A linear or curvilinear relationship?
2017, Computers in Human Behavior
This paper reports the effect of website interactivity on change in smokers' behavioral intention to quit with a pretest-posttest design experiment. An online experiment with 92 smokers tested the effect of the number of interactive features on the website ranging from zero to three. An inverted U-shaped quadratic trend was found in perceived interactivity, which indirectly influenced the change score of participants’ behavioral intention to quit after browsing.
Only one or two interactive features, not three, led to a significant increase in the change score compared with the control condition, by increasing vividness of the stimulus website and decreasing defensive responses. However, for smokers who are highly addicted, the website with three interactive features decreased their defensive responses and led to greater change in behavioral intention to quit compared with other less interactive conditions.

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^☆: The Copenhagen Center for Prospective Population Studies (Director: M. Grønbæk; Steering group: Chairman: T. I. A. Sørensen, J. Vestbo, P. Schnohr, H. O. Hein, N. Keiding, and T. Jørgensen) consists of the Copenhagen County Centre for Preventive Medicine (T. Jørgensen, H. Ibsen, K. Borch-Johnsen, P. Thorvaldsen, and T. Thomsen), The Copenhagen Male Study (H. O. Hein, F. Gyntelberg, and P. Suadicani), and The Copenhagen City Heart Study (G. Jensen, P. Schnohr, J. Nyboe, B. Nordestgaard, M. Appleyard, P. Lange, and M. Grønbæk).

¹: To whom correspondence and reprint requests should be addressed. Fax: +4535351181. E-mail: [email protected].

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Regular ArticleGender and Determinants of Smoking Cessation: A Longitudinal Study☆

Abstract

Soc Sci Med

J Clin Epidemiol

Addict Behav

Soc Sci Med

Soc Sci Med

Trends in smoking prevalence in Danish adults, 1964–1994. The influence of gender, age and education

Scand J Soc Med

Regular Article
Gender and Determinants of Smoking Cessation: A Longitudinal Study☆