Adherence to treatment to help quit smoking: effects of task performance and coping with withdrawal symptoms

BMC Public Health Adherence to treatment to help quit smoking: effects of task performance and coping with withdrawal symptoms Francisca Lpez-Torrecillas Maria Mar Rueda Eva Mara Lpez-Quirantes Javier Machado Santiago Reyes Rodrguez Tapioles Background: Currently the combined cognitive-behavioral and pharmacological treatment is the best option to quit smoking, although success rates remain moderate. This study aimed to identify predictors of continuous abstinence in an assisted smoking cessation program using combined treatment. In particular, we analyzed the effects of socio-demographic, smoking-, and treatment-related variables. In addition, we analyzed the effect of several risk factors on abstinence, and estimated a model of risk for smoking relapse. Methods: Participants were 125 workers at the University of Granada (50 males), with an average age of 46.91 years (SD = 8.15). They were recruited between 2009 and 2013 at an occupational health clinic providing smoking cessation treatment. Baseline measures included socio-demographic data, preferred brand of cigarettes, number of years smoking, use of alcohol and/or tranquilizers, past attempts to quit, Fargerstrm Test for Nicotine Dependence, Smoking Processes of Change Scale, and Coping with Withdrawal Symptoms Interview. Participants were invited to a face-to-face assessment of smoking abstinence using self-report and cooximetry hemoglobin measures at 3, 6, and 12 months follow-up. The main outcome was smoking status coded as relapse versus abstinence at each follow-up. Kaplan-Meier survival analysis was performed to estimate the probability of continued abstinence during 12 months and log-rank tests were used to analyze differences in continued abstinence as a function of socio-demographic, smoking-, and treatment-related variables. Cox regression was used to analyze the simultaneous effect of several risk factors on abstinence. Results: Using alcohol and/or tranquilizers was related to shorter abstinence. Physical exercise, the number of treatment sessions, performance of treatment tasks, and coping with withdrawal symptoms were related to prolonged abstinence. In particular, failure to perform the treatment tasks tripled the risk of relapse, while lack of coping doubled it. Conclusions: Our results show that physical exercise, performance of treatment-related tasks, and effective coping with withdrawal symptoms can prolong abstinence from smoking. Programs designed to help quit smoking can benefit from the inclusion of these factors. Treatment to quit smoking; Treatment adherence - Background Tobacco consumption remains the number one preventable cause of morbidity and mortality, responsible for 31% of lung cancer cases. Other types of cancer associated with tobacco consumption are lip, mouth, pharynx, larynx, esophagus, bladder, and kidney cancer. Further, exposure to environmental (i.e., second hand) tobacco smoke increases the risk of lung cancer, as well as the risk of suffering respiratory, cardiovascular, and other chronic diseases [1]. Despite several decades of falling smoking prevalence rates, the National Spanish Health Survey [2] now shows that this decline has stalled, with 27.9% of men and 20.2% of women over age 16 smoking daily. Currently the combined cognitive-behavioral and pharmacological treatment is the best option to quit smoking [3-8]. General population surveys show that about 70% of smokers would like to quit and about 30-40% try to do so, but the proportion of those who succeed is less than 5% [9-11]. Recent studies have identified a number of variables associated with success at quitting smoking [12-19]. Among these are socio-demographic variables such as age, gender, education level, and occupation. To illustrate, younger men (aged 22-38 years) are more likely to continue smoking than older men [18] and women are less likely to quit than men [13]; education level and occupation have not been associated with quitting success [16]. Other factors investigated extensively are the severity of tobacco dependence and its relation to treatment outcomes. In particular, the number of cigarettes, the intensity of tobacco dependence, and alcohol consumption decrease the probability of quitting [15-17]. Treatment-related variables can also influence quitting success. For example, past attempts to quit predicted abstinence during the first week and sustained abstinence during 6 months in a second attempt to quit [15]. Another factor that can influence treatment adherence is the number of treatment sessions [4,19]. For example, having completed more than four treatment sessions and performed treatment tasks predicted abstinence at 6 months [17]. Finally, the motivation to change has also been related to quitting success [20]. Treatment adherence is defined as the degree to which the person's behavior follows health recommendations. It includes the patient's ability to attend scheduled appointments, take medications as indicated, make the recommended changes in lifestyle, and complete the laboratory studies or tests requested [21]. There are several methods to measure treatment adherence and each of them has some limitations. Hence, several methods should be used simultaneously in order to gather as much information as possible. For instance, it has been proposed to use three variables to assess adherence: the completion of tasks assigned during treatment, the number of completed treatment sessions, and the extent of coping with withdrawal symptoms [22]. Finally, some studies emphasize the role of physical exercise in coping with craving and withdrawal symptoms (depressed mood, negative affect, insomnia, stress, and weight gain) [23-25]. For instance, performing moderate exercise reduces craving and this effect is maintained for more than 20 minutes after exercise completion [26,27]. The objective of this study was to identify predictors of continuous abstinence during 12 months in an assisted smoking cessation program. In particular, we investigated the influence of socio-demographic variables (age, gender, education level, and occupation), smoking-related variables (cigarette brand, nicotine concentration mg per cigarette, number of cigarettes smoked daily, nicotine dependence, years of smoking, use of alcohol and/or tranquilizers) and treatment-related variables (past attempts to quit, compliance with the pharmacological therapy, performance of treatment tasks, number of treatment sessions, coping with withdrawal symptoms, and physical exercise). Finally, we analyzed the simultaneous effect of several risk factors on abstinence and estimated a model of risk for smoking relapse. Methods Participants Participants were 125 workers at the University of Granada (50 men and 75 women) with a mean age of 46.91 years (SD = 8.15). They were recruited between 2009 and 2013 at an occupational health clinic providing smoking cessation treatment. Participants smoked a mean number of 19.86 (SD = 8.95) (...truncated)