This article reviews findings and examines theoretical implications of studies concerned with initiation, maintenance, and therapy of cigarette smoking in children and adults. The following conclusions are offered: (a) Recent increases in success rates may be due to changes in the social environment that multiply the action of previously unsuccessful procedures, (b) current interventions are based on communication and behavioral models that ignore features unique to smoking, (c) methodological refinements of current interventions are unlikely to significantly increase success rates, (d) prevention studies should be directed toward critical steps in the developmental history of smoking (e.g., preventing initial attempts, facilitating negative interpretations of initial attempts, and retarding regular usage), and (e) studies of cessation and withdrawal must consider findings and theories of nicotine dependence. A hypothesis is presented to account for the development of craving conditioned to internal and external cues, and suggestions about how to eliminate the craving state are made.

The smoking problem: a review of the research and theory in behavioral risk modification.

The utility and validity of Bandura's self-efficacy theory and Marlatt's theoretical model of relapse were evaluated in a study of 78 cigarette smokers from two different cessation programs. Pretreatment, posttreatment, and follow-up assessments of smoking behavior, self-efficacy, and mood states were obtained. Efficacy state was found to be significantly enhanced as the result of both treatment programs. Subjects' scores on the seven clusters from the posttreatment efficacy state inventory were used as predictor variables in a multiple regression analysis to predict which subjects would relapse and how long, on a dichotomous time variable, they would remain abstinent before relapse. Multiple correlations, corrected for shrinkage, were .57 for relapse and .69 for time to relapse. A microanalysis revealed an extremely high correspondence between the cluster of smoking situations in which relapsing subjects experienced a low degree of selfefficacy and the situation in which relapse first occurred (weighted kappa = .89). Analysis of mood and efficacy data during follow-up indicated that relapsing subjects demonstrated aspects of a cognitive dissonance reaction and a personal attribution effect that were consistent with Marlatt's description of the abstinence violation effect. Research and clinical implications of the findings are discussed.

Self-efficacy and relapse in smoking cessation programs.

In a systematic review of the efficacy of interventions intended to help people stop smoking, data have been analyzed from 188 randomized controlled trials. Following personal advice and encouragement to stop smoking given by physicians during a single routine consultation, an estimated 2% (95% confidence limits, 1%, 3%; P P =.05) but no greater than simple advice by a physician (2%); yet, these techniques are several times more expensive. The effect of hypnosis is unproved (no trials have used biochemical markers). Nicotine replacement therapy is effective in an estimated 13% of smokers who seek help in cessation; the effect is greater in those who are nicotine-dependent. Other pharmacological treatments are not of proven efficacy, and acupuncture is ineffective. Sudden cessation or gradual reduction in smoking are similar in their efficacy on average. Physicians should take time to advise all their patients who smoke to quit. Smokers who are intent on stopping should be given additional support and encouraged to use nicotine replacement therapy. (Arch Intern Med. 1995;155:1933-1941)

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=intemed&articleId=621064&pdfFileName=archinte_155_18_004.pdf

An Analysis of the Effectiveness of Interventions Intended to Help People Stop Smoking

Deux etudes longitudinales, prospectives, examinent le role du soutien social dans le maintien de la decision de ne plus fumer: soutien d'un partenaire; existence d'un climat social encourageant le sevrage; participation a un reseau social. Part de chacun des facteurs dans le maintien de la decision et l'absence de rechute. Etudes psychometriques

David P. Schmahl

Papers

Comparison of Rapid Smoking, Warm, Smoky Air, and Attention Placebo in the Modification of Smoking Behavior.

Successful treatment of habitual smokers with warm, smoky air and rapid smoking.