Background: Tobacco use remains a major public health issue. Population-level efforts to curb tobacco use include media to promote smoking cessation. However, these campaigns (including tobacco package warning labels) commonly emphasize the addictiveness of nicotine and the difficulty of quitting with statements like ?nicotine is as addictive as heroin and cocaine?. Addiction oriented messages may have an iatrogenic effect on cessation by undermining behavioural precursors such as self-efficacy, cessation outcome expectations, behavioural control, and quit-aid efficacy. <br /><br /> Objectives: First, to determine the effects of addiction focused messages in comparison to efficacy enhanced messages and control messages on smokers? self-efficacy, cessation outcome expectations, behavioural control, and quit-aid efficacy. Second, to determine if the impact of addiction focused messages differ according to participant nicotine dependency level. <br /><br /> Methods: A sample of adult smokers (n>101) from Kitchener/Waterloo and Owen Sound were randomly assigned into one of three intervention conditions: addiction focused (M1), efficacy enhanced (M2), and control (M3). Outcome measures were collected at baseline, post intervention and 30-day follow-up and included: self-efficacy, outcome expectations, behavioural control, quit-aid efficacy, and outcome expectancies. The 30-day follow-up also included measures of smoking consumption, quit attempts and use of a quit-aid. <br /><br /> Results: Majority of the participants were males and between 18-25 years of age. Mean number of cigarettes smoked ranged from 12 to 15 across groups whereas the mean number of years smoked ranged from 12 to 17. General linear analyses revealed no significant effect of message type or nicotine dependence (as measured by the Fagerstrome Test for Nicotine Dependence) on the outcome variables of interest. However, when perceived addiction was substituted as the measure of nicotine dependence, the analysis revealed a main effect for nicotine dependence on self-efficacy post intervention and on cessation outcome expectations at follow-up. An interaction effect was found for outcome expectancy at post intervention. <br /><br /> Conclusion: The results of this study suggest that acute addiction oriented messages may not negatively impact smokers? self-efficacy, outcomes expectations, behavioural control, quit-aid efficacy, and outcome expectancies. However, this does mean that message orientation should be ignored when constructing smoking cessation messages. In fact, program designers are encouraged to employ messages that limit the use of addiction oriented statements such as ?nicotine is as addictive as heroin and cocaine?. Further research is required to examine the potential cumulative impact of addiction oriented messages on quitting behaviour and its precursors.

(DSM-IV-TR/) nor in withdrawal scales. However, a related term, "impatience" is listed in some nicotine withdrawal scales. (Hughes J. R., Measurements of the Effects of Abstinence from Tobacco: A Qualitative Review, 2007). Although impatience is not a synonym of impulsivity, both share the synonym "impetuous". Therefore, impatience can be considered a measure of impulsivity. Although some reviews of the effect of smoking cessation on impatience have occurred, we know of no quantitative review of prospective studies of whether smoking cessation increases impatience. Purpose: To evaluate the effect of smoking cessation on impatience as measured by the Minnesota Nicotine Withdrawal Scale-Revised (MNWS). Methods: A literature search of MEDLINE (PubMED), EMBASE, and PsychInfo was conducted. Articles containing relevant keywords were reviewed by two evaluators independently. To be considered for inclusion in the meta-analysis, studies had to be prospective studies, had to have pre-cessation impatience measurements, to include at least overnight abstinence, had to have smoking abstinence biochemically verified, and had to include effect size as an outcome measure. Results: All pooled analyses were based on random-effects models. Seven trials met the selection criteria. The total number of subjects was 426. There was a significant level of heterogeneity among studies (X2(6), pI2= 89%). The summary mean effect for impatience after tobacco cessation was an increase of .44 on a 0-3 scale (95% confidence interval [CI], 0.21-0.67) and a p-value Conclusion: The meta-analysis shows that impulsivity increases post smoking cessation. These findings imply that smoking cessation may have an effect on decision making. Additionally higher rates of impulsivity have been associated with smoking relapse. (Doran, Spring, McChargue, Peradia, & Richmond, 2004). In order to better assist in the development of individual treatments, a better understanding is needed of how increased impulsivity influences cognitive behavior and relapse rates. These findings support the inclusion of impulsivity as a criterion for nicotine withdrawal.

Delay discounting is considered by many to be a risk factor for substance use disorders and other health-related behavior problems. While these health-related behavior problems are often treated with incentive-based interventions, little is known about whether delay discounting (DD) moderates response to that treatment approach. The present study examined how response to incentive-based smoking-cessation treatment varied as a function of baseline DD scores among pregnant women participating in randomized controlled clinical trials examining the efficacy of financial incentives. Women were assigned to a condition wherein they earned vouchers exchangeable for retail items contingent on abstinence from recent smoking or to a control condition wherein they received vouchers of comparable value but independent of smoking status. Individual differences in DD of hypothetical monetary rewards were measured at the study intake and follow-up assessments. We examined whether individual differences in baseline scores on that instrument predict antepartum and postpartum smoking status using logistic regression, and if sustaining abstinence caused changes in DD scores from intake to 24-weeks postpartum. We did not see any significant main effects of DD or interactions of DD with treatment on antepartum or postpartum smoking status. Treatment condition, baseline smoking rate (cigs/day), a history of quit attempts pre-pregnancy, and educational attainment were all associated with increased odds of abstaining from smoking at the late-pregnancy antepartum assessment, and treatment condition was the only significant predictor of abstaining from smoking at 24-weeks postpartum, three months after the treatment formally ended. We saw no discernible evidence that sustained abstinence from smoking was associated with post-treatment decreases in DD. Overall, we saw no evidence that being a steeper discounter is associated with a lack of success in quitting smoking in either treatment condition. Being assigned to the incentives condition was the only predictor of antepartum and postpartum abstinence. The observed associations of a lower baseline smoking rate, higher educational attainment, and a history of having attempted to quit smoking previously with increased odds of success in achieving antepartum smoking abstinence is consistent with results from previous reports on predictors of response to this treatment underscoring the reliability of these relationships.

Depressive symptoms are more common among sedentary individuals with longitudinal studies supporting inactivity as a potential risk factor for mood disturbances. Observational and experimental designs find that lack of exercise or exercise deprivation is associated with increased depressive and anxiety symptoms, fatigue, and pain. However, literature has not examined risk factors influencing mood deterioration in response to exercise deprivation. The current study tested the hypothesis that physically active individuals with high levels of cognitive vulnerability (i.e., a tendency towards negative thought content and processes when under stress) are at high risk for mood disturbance when undergoing exercise cessation. Community adults who met guidelines for recommended physical activity (N=36) were examined in a 4-week prospective, longitudinal study. Mood was assessed with the Beck Depression Inventory-Second Edition, the Beck Anxiety Inventory, and the Brief Profile of Mood States at baseline, after two weeks of maintained exercise, and after one and two weeks of exercise cessation. Cognitive vulnerability variables (i.e., dysfunctional attitudes, brooding rumination, cognitive reactivity) were assessed following the maintained exercise phase. Similar to prior studies, results indicated a main effect of time, such that depressive and anxiety symptoms increased over the exercise cessation protocol. Results additionally lend support for a vulnerability-stress model, with brooding rumination identified as a risk factor for the development of symptoms during exercise deprivation. This study suggests that individuals who engage in brooding rumination to cope with negative affect are at elevated risk for mood symptoms when ceasing their exercise routine.

O tabagismo é o mais importante fator de risco de diversas doenças crônicas, incluindo a periodontite. Atualmente existe uma mobilização mundial contra o uso do tabaco. Embora cirurgiões-dentistas apresentem potencial para ajudar seus pacientes fumantes a abandonar o vicio, o papel do dentista na cessação do tabagismo ainda não está totalmente esclarecido. O objetivo deste estudo prospectivo de 12 meses foi verificar o efeito de um programa antitabágico multidisciplinar na cessação de tabagismo em fumantes com doença periodontal. Duzentos e um (201) sujeitos foram triados, e 93 foram incluídos e receberam tratamento periodontal não-cirúrgico. Simultaneamente, os indivíduos receberam terapia antitabágica, que consistiu em quatro palestras consecutivas ministradas por um médico e uma dentista, terapia cognitiva comportamental realizada por uma psicóloga, e terapia de reposição de nicotina e medicação, de acordo com necessidades individuais. Durante o tratamento periodontal, os dentistas motivaram ativamente os participantes a pararem de fumar, usando técnicas de entrevista motivacional. Aconselhamento e suporte adicionais foram fornecidos durante as visitas de manutenção após 3, 6 e 12 meses do término do tratamento periodontal. A condição de tabagista foi avaliada por meio de um questionário estruturado, e foi validada pela mensuração de monóxido de carbono expirado (CO). Também foi aplicado o Questionário de Tolerância de Fagerström para verificar a dependência à nicotina. Dentre os 52 indivíduos que permaneceram até o exame de 12 meses, 22(42,31%), 17(32,69%) e 17(32,69%) não estavam fumando após 3, 6 e 12 meses, respectivamente. A cessação de tabagismo foi associada aos níveis iniciais de CO (p = 0,03), nível de dependência nicotínica de acordo com o questionário de Fageström (p=0,01) e escore médio do questionário de Fagerström (p<0,001). Concluiu-se que a terapia antitabágica realizada por uma equipe multidisciplinar que inclui dentistas resultou em alta taxa de cessação de tabagismo. O abandono do hábito foi associado à exposição ao CO e à dependência nicotínica. / Smoking is the leading risk factor of several chronic diseases, including periodontitis. Nowadays, there is a world-wide mobilization against the use of tobacco. Although it is acknowledged that dentists have potential to help smoking patients to quit, their role in tobacco control is not completely defined. The aim of this prospective 12- month study was to evaluate the effect of a multidisciplinary smoking cessation program in quitting smoking in subjects with periodontal disease. Two-hundred and one (201) subjects were screened, and 93 were included and received non-surgical periodontal treatment during four weeks. Subjects also received smoking cessation therapy, which consisted of four consecutive lectures given by a physician and a dentist, psychologist-assisted cognitive behavioral therapy, nicotine replacement therapy and medication, according to their individual needs. During initial periodontal treatment, dentists actively motivated the study subjects to stop smoking, using motivational interviewing techniques. Further smoking cessation counseling and support were also provided by the dentists during periodontal maintenance sessions at 3, 6 and 12 months of follow-up. Smoking status was assessed by means of a structured questionnaire, and it was validated by exhaled carbon monoxide (CO) measurements. Participants were further asked about their nicotine dependence, by means of the Fagerström Tolerance Questionnaire. Among the 52 individuals that remained up to the 12-months examination, 22(42.31%), 17(32.69%) and 17(32.69%) were not smoking at 3, 6 and 12 months, respectively. Smoking cessation was associated with baseline CO levels (p = 0.03), Fagerströms nicotine dependence level (p=0.01) and mean Fagerström test score (p<0.001). It is concluded that smoking cessation therapy performed by a multidisciplinary team including dentists resulted in high quit rates. Smoking cessation was associated with exposure to CO and nicotine dependence.

Background: Current smoking-cessation medicines can assist smokers to quit, but have limited efficacy. Supplementing them with a replacement for the sensory and behavioural aspects of smoking, which are hypothesised to act as secondary reinforcers, could in theory help to alleviate urges to smoke and withdrawal, and may assist smoking cessation. Methods: Three studies were conducted to examine sensorimotor replacement (SMR) effects. The first two employed a cross-over design to assess the effects of two SMR products, nicotine-free electronic cigarettes (ECs) and de-nicotinised cigarettes (DNCs), on short-term withdrawal, urges to smoke, and user acceptability. Study 1 (N= 35), compared EC to a stress ball (SB) to control for behavioural distraction and Study 2 (N=41) tested whether SMR effects were ‘dose dependent’ by comparing DNCs with ECs. The final study was part of a randomised controlled trial (N= 200) of DNCs in combination with standard treatment. It examined whether SMR effects on abstinence are moderated by scores on a ‘behavioural’ dependence measure (GN-SBQ). Results: The EC was preferred over the SB, and alleviated urge to smoke more than SB, but the effect was modest and short-lived. The DNC and EC had similar effects acutely, but DNC suppressed urges to smoke and withdrawal to a somewhat greater extent over a day of abstinence. DNCs combined with standard smoking-cessation treatment improved short-term abstinence regardless of GN-SBQ scores. Conclusion: SMR effects on urge and withdrawal alleviation were modest and a ‘dose response’ effect was not clearly established. An attempt to identify smokers for whom SMR may be of particular benefit was not successful. SMR however, was perceived as helpful and appealing, and results from the trial suggest that adding SMR may enhance existing treatments. It was proposed that rather than directly alleviating urges/withdrawal, SMR may operate as a coping tool in ‘high-risk’ situations, by providing an alternative to smoking.

O tabagismo é o mais importante fator de risco de diversas doenças crônicas, incluindo a periodontite. Atualmente existe uma mobilização mundial contra o uso do tabaco. Embora cirurgiões-dentistas apresentem potencial para ajudar seus pacientes fumantes a abandonar o vicio, o papel do dentista na cessação do tabagismo ainda não está totalmente esclarecido. O objetivo deste estudo prospectivo de 12 meses foi verificar o efeito de um programa antitabágico multidisciplinar na cessação de tabagismo em fumantes com doença periodontal. Duzentos e um (201) sujeitos foram triados, e 93 foram incluídos e receberam tratamento periodontal não-cirúrgico. Simultaneamente, os indivíduos receberam terapia antitabágica, que consistiu em quatro palestras consecutivas ministradas por um médico e uma dentista, terapia cognitiva comportamental realizada por uma psicóloga, e terapia de reposição de nicotina e medicação, de acordo com necessidades individuais. Durante o tratamento periodontal, os dentistas motivaram ativamente os participantes a pararem de fumar, usando técnicas de entrevista motivacional. Aconselhamento e suporte adicionais foram fornecidos durante as visitas de manutenção após 3, 6 e 12 meses do término do tratamento periodontal. A condição de tabagista foi avaliada por meio de um questionário estruturado, e foi validada pela mensuração de monóxido de carbono expirado (CO). Também foi aplicado o Questionário de Tolerância de Fagerström para verificar a dependência à nicotina. Dentre os 52 indivíduos que permaneceram até o exame de 12 meses, 22(42,31%), 17(32,69%) e 17(32,69%) não estavam fumando após 3, 6 e 12 meses, respectivamente. A cessação de tabagismo foi associada aos níveis iniciais de CO (p = 0,03), nível de dependência nicotínica de acordo com o questionário de Fageström (p=0,01) e escore médio do questionário de Fagerström (p<0,001). Concluiu-se que a terapia antitabágica realizada por uma equipe multidisciplinar que inclui dentistas resultou em alta taxa de cessação de tabagismo. O abandono do hábito foi associado à exposição ao CO e à dependência nicotínica. / Smoking is the leading risk factor of several chronic diseases, including periodontitis. Nowadays, there is a world-wide mobilization against the use of tobacco. Although it is acknowledged that dentists have potential to help smoking patients to quit, their role in tobacco control is not completely defined. The aim of this prospective 12- month study was to evaluate the effect of a multidisciplinary smoking cessation program in quitting smoking in subjects with periodontal disease. Two-hundred and one (201) subjects were screened, and 93 were included and received non-surgical periodontal treatment during four weeks. Subjects also received smoking cessation therapy, which consisted of four consecutive lectures given by a physician and a dentist, psychologist-assisted cognitive behavioral therapy, nicotine replacement therapy and medication, according to their individual needs. During initial periodontal treatment, dentists actively motivated the study subjects to stop smoking, using motivational interviewing techniques. Further smoking cessation counseling and support were also provided by the dentists during periodontal maintenance sessions at 3, 6 and 12 months of follow-up. Smoking status was assessed by means of a structured questionnaire, and it was validated by exhaled carbon monoxide (CO) measurements. Participants were further asked about their nicotine dependence, by means of the Fagerström Tolerance Questionnaire. Among the 52 individuals that remained up to the 12-months examination, 22(42.31%), 17(32.69%) and 17(32.69%) were not smoking at 3, 6 and 12 months, respectively. Smoking cessation was associated with baseline CO levels (p = 0.03), Fagerströms nicotine dependence level (p=0.01) and mean Fagerström test score (p<0.001). It is concluded that smoking cessation therapy performed by a multidisciplinary team including dentists resulted in high quit rates. Smoking cessation was associated with exposure to CO and nicotine dependence.

Smoking remains a leading cause of disability and mortality worldwide. Despite declining rates of smoking in developed countries, smoking prevalence remains high, and there is evidence that it has plateaued in recent years. Individuals with a comorbid psychiatric diagnosis represent a disproportionate percentage of those who continue to smoke and are particularly at-risk given they smoke at higher rates and consume more cigarettes compared to those with no diagnosis. Moreover, these individuals are often excluded from clinical trials of smoking cessation, making it difficult to generalize results of previous intervention studies. In the general literature of smoking cessation, smoking cessation self-efficacy, or one’s confidence in their ability to abstain from smoking, is a consistent predictor of positive abstinence outcomes. The overall purpose of this dissertation was to investigate smoking cessation self-efficacy as a predictor of abstinence outcomes in a population of treatment-seeking smokers with and without a history of psychiatric illness. To accomplish this, articles 1 and 2 investigated the psychometric properties of a multi-item measure of cessation self-efficacy. This entailed comparing the measure to other indices of smoking, and conducting a confirmatory factor analysis to ensure factor invariance and equivalence of the measure regardless of psychiatric status. We found a moderate correlation between our multi-item scale to a single-item measure of confidence to quit, as well as support for both the original two-factor model as well as a three-factor model, which explained 79.3% of the variance. Our results also supported the measure as being factor invariant across psychiatric diagnoses. Next, articles 3 and 4 investigated how this measure of cessation self-efficacy predicted several smoking outcomes (10-, 22- and 52-weeks following target-quit date), and whether this relationship was mediated by concurrent smoking and other interpersonal-indices of smoking cessation (nicotine withdrawal, negative affect). In article 3, we found support for a bidirectional and reciprocal relationship between smoking cessation self-efficacy and smoking status. While changes in concurrent behavior (smoking or abstinent) did impact subsequent evaluations of self-efficacy, the inverse was also true. Moreover, both concurrent smoking and cessation self-efficacy predicted outcomes at week 10. Article 4 built on this framework and investigated this relationship at 22- and 52-weeks post-target quit-date. Our results highlight the robust association between cessation self-efficacy and abstinence. Higher cessation self-efficacy was positively associated with better abstinence outcomes, even after controlling for concurrent smoking, withdrawal, and negative affect. Further, there was evidence that cessation self-efficacy partially mediated the impact of withdrawal and negative affect. In our fully adjusted model (adjusting for demographic characteristics, baseline smoking levels, withdrawal and negative affect), cessation self-efficacy along among the interpersonal-determinants predicted abstinence outcomes (Odds ratio = 1.078, 95% confidence interval (1.068 - 1.089). This was true for those with either a current, past, or no lifetime psychiatric diagnosis, and despite the finding that individuals in the lifetime (current or past diagnosis) category experienced overall lower self-efficacy. Overall, our results support the value of cessation self-efficacy as an important indicator of abstinence outcomes, and particularly highlight its potential utility for at-risk populations of comorbid psychiatric smokers.

According to the American Medical Association (AMA), smoking is the greatest cause of preventable illness and death in the United States. In 1997, the Centers for Disease Control and Prevention (CDC) stated that 29% of college students reported current cigarette use. The purpose of this study is to assess students' responses toward administering a smoking cessation program at a state university. This study was conducted at a state university where the researcher surveyed 319 students using a 27-item questionnaire. The survey questions include student demographics; age first smoked; frequency and amount of smoking; places they smoked the most; how soon they smoked after waking up; methods and attempts to quit; and perceptions regarding smoking and their health. Results from the study found statistically significant associations between smoking and the variables: academic classification and attempts to quit. However, there were no significant associations between smoking and age, gender, ethnicity, and residence. Other findings indicated that more than half of student smokers were female and more than half of student smokers were also in the first three years of college. Lack of time and cost were the main factors given as preventing smokers from receiving assistance from the university's smoking cessation program. In addition, student smokers reported shortness of breath, bad breath, stained teeth, decreased sense of smell and taste, increased heart rate, and loss of appetite. Recommendations include assessment, policy development, and assurance. Assessment helps to develop goals and objectives of the smoking cessation program. At the same time, it indicates the strengths and weaknesses of the program. The development of policies must be enforced to reduce or control the number of student smokers, especially in the dormitories. Finally, student smokers willing to receive assistance from the program must be assured that the services provided are free, safe, and efficient.

Smoking cessation can reduce health risk and prevent millions of tobacco-related deaths. However, cessation rates are low in low-and-middle income countries (LMICs), with only a small proportion of smokers intending to quit. Given the paucity of literature to support tobacco cessation programs in LMICs, this study aimed to: 1) identify factors associated with intention to quit smoking, 2) assess the relationship between health care provider quit advice/tobacco screening and utilization of cessation assistance, and 3) examine the relationship between home smoking rule and smoking intensity across three stages of smoking cessation (precontemplation, contemplation and preparation) in LMICs. Data were obtained from the Global Adult Tobacco Survey, 2009-2012, a nationally representative household survey of noninstitutionalized civilians aged 15 years and older. Weighted multivariable regression analyses were conducted using SAS version 9.4. Adjusted odds ratios (OR), percent change in smoking intensity and associated 95% confidence intervals (CI) were estimated. Home smoking rule and exposure to anti-smoking messages were the important factors associated with contemplation and preparation to quit smoking. Approximately 1%, 7%, 9% and 15% used quitline, medical treatment, counseling/cessation clinic and cessation assistance (all three combined), respectively, in the past year. Quit advice was significantly associated with utilization of counseling/cessation clinic (OR=3.89, 95% CI=2.8–5.5), medical treatment (OR=1.71, 95% CI=1.2–2.4) and cessation assistance (OR=2.60, 95% CI=2.0–3.4). Tobacco screening was associated with utilization of counseling/cessation clinic (OR=2.60, 95% CI=1.1–5.9) and medical treatment (OR=1.71, 95% CI=1.2–2.4). Living in a completely smoke-free home was associated with a 22.5% (95% CI=17.1%–28.0%), an 18.6% (95% CI=9.0%–28.2%), and a 19.4% (95% CI=3.9%–34.9%) significant reduction in smoking intensity among smokers in precontemplation, contemplation and preparation, respectively. In conclusion, the results suggest that smoke-free home, anti-smoking campaigns, and health care provider intervention promote smoking cessation in LMICs. Therefore, comprehensive smoke-free policies, anti-smoking media campaigns and integration of tobacco screening and quit advice into the health care system are important for tobacco cessation in LMICs, suggesting the need for full implementation of the World Health Organization Framework Convention for Tobacco Control Articles 8 and 11 – 13.