Dataset Information

Pain Status as a Predictor of Smoking Cessation Initiation, Lapse, and Relapse.

ABSTRACT:

Introduction

Pain and cigarette smoking are highly prevalent and frequently co-occurring conditions that interact in the manner of a positive feedback loop. Despite initial evidence that smokers with co-occurring pain may experience greater difficulty quitting, we are unaware of previous research that has tested prospective associations between pain status and the attainment of smoking cessation milestones.

Aims and methods

This study examined past 2-week pain status as a predictor of cessation milestones among current smokers who were motivated to quit (Sample 1; N = 301) and smokers who recently initiated a cessation attempt (Sample 2; N = 242). Cessation milestones included initiation of a quit attempt and 7-day point prevalence abstinence (PPA; Sample 1), lapse/relapse (Sample 2), and 7-day PPA at 2-month follow-up (both samples). Indirect associations between pain status and cessation milestones via confidence in quitting and nicotine withdrawal were also examined.

Results

Smokers with pain (vs. no pain) were as follows: less likely to initiate a quit attempt and achieve 7-day PPA; more likely to lapse and/or relapse; and less likely to report 7-day PPA at follow-up. Pain status was indirectly associated with latency cessation milestones via confidence in quitting and with latency to lapse via withdrawal severity.

Conclusions

This study demonstrated that pain status can predict smoking cessation outcomes. Clinical implications include the need to assess pain in the context of quitting and that smokers with co-occurring pain may benefit from tailored/integrated cessation interventions.

Implications

A growing empirical literature indicates that the presence of co-occurring pain probably contributes to the maintenance of cigarette dependence. The current results provide novel evidence that smokers with co-occurring past 2-week pain are less likely to initiate a quit attempt and maintain smoking abstinence than smokers without co-occurring pain. These findings suggest that smokers with pain face unique barriers to quitting and underscore the utility of assessing and addressing pain among all smokers who are planning a smoking cessation attempt.

SUBMITTER: Ditre JW

PROVIDER: S-EPMC7789944 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:There is little knowledge about how emotion regulation difficulties interplay with psychopathology in terms of smoking cessation. Participants (n = 250; 53.2 % female, Mage = 39.5, SD = 13.85) were community-recruited daily smokers (?8 cigarettes per day) who self-reported motivation to quit smoking; 38.8 % of the sample met criteria for a current (past 12-month) psychological disorder. Emotion regulation deficits were assessed pre-quit using the Difficulties with Emotion Regulation Scale (DERS; Gratz and Roemer in J Psychopathol Behav Assess 26(1):41-54, 2004) and smoking behavior in the 28 days post-quit was assessed using the Timeline Follow-Back (TLFB; Sobell and Sobell in Measuring alcohol consumption: psychosocial and biochemical methods. Humana Press, Totowa, 1992). A Cox proportional-hazard regression analysis was used to model the effects of past-year psychopathology, DERS (total score), and their interaction, in terms of time to lapse post-quit day. After adjusting for the effects of gender, age, pre-quit level of nicotine dependence, and treatment condition, the model revealed a non-significant effect of past-year psychopathology (OR = 1.14, CI95 % = 0.82-1.61) and difficulties with emotion regulation (OR = 1.01, CI95 % = 1.00-1.01) on likelihood of lapse rate. However, the interactive effect of psychopathology status and difficulties with emotion regulation was significant (OR = 0.98, CI95 % = 0.97-0.99). Specifically, there was a significant conditional effect of psychopathology status on lapse rate likelihood at low, but not high, levels of emotion regulation difficulties. Plots of the cumulative survival functions indicated that for smokers without a past-year psychological disorder, those with lower DERS scores relative to elevated DERS scores had significantly lower likelihood of early smoking lapse, whereas for smokers with past-year psychopathology, DERS scores did not differentially impact lapse rate likelihood. Smokers with emotion regulation difficulties may have challenges quitting, and not having such difficulties, especially without psychopathology, decreases the potential likelihood of early lapse.

Project description:IntroductionGreater use of nicotine replacement therapy (NRT) is related to smoking cessation success, but the causal direction is unclear. This study characterized the relationship between NRT use and smoking lapse and relapse.MethodsParticipants (N = 416 smokers; 57% female, 85% White) were recruited from primary care for a smoking cessation factorial experiment and analyzed if abstaining ≥1 day in the first 2 weeks post-target quit day (TQD). Participants were randomized to counseling and 8 versus 26 weeks of nicotine patch plus nicotine gum post-TQD. Participants carried electronic dispensers that timestamped each gum use. Participants who lapsed (smoked after abstaining) within 6 weeks post-TQD were matched with nonlapsers (n = 146 pairs) on multiple variables. We compared lapsers' versus matched nonlapsers' gum use in the 5 days before and after the lapsers' first lapse.ResultsBy week 6 post-TQD, 63% of participants lapsed. Compared with nonlapsers, lapsers used less gum 1 and 2 days pre-"lapse" and on the 5 days post-lapse. Lapsers used less gum during the 5 days post-lapse than the 5 days pre-lapse. Univariate survival analyses with lapsers showed greater gum use during both pre- and post-lapse periods predicted longer latency to relapse in the first 6 weeks.ConclusionsIn a smoking cessation attempt using nicotine patch plus gum, lapsers versus matched nonlapsers used less gum immediately preceding and following their first lapse. Lower mean gum use before and after lapses predicted a more rapid escalation to relapse. Decreased nicotine gum use both precedes and follows returns to smoking during cessation attempts.ImplicationsThis research examined electronically monitored nicotine gum use collected in real time and found that among smokers engaged in a quit attempt, lapsers (vs. matched nonlapsers) tended to decrease their gum use 1-2 days prior to lapsing and to further decrease their gum use from pre- to post-lapse. Decreased gum use pre-lapse may signal heightened lapse risk in 1-2 days, with lower level of gum use predicting a more precipitous course of relapse. These results encourage further exploration of objective measures of smoking medication use patterns to examine their signaling properties and to inform understanding of cessation failure.Clinical trial registrationClinicalTrials.gov NCT01120704.