J Am Geriatr Soc 1993 Dec;41(12):1313-6

Depression and smoking cessation in older adults: a longitudinal study.
Salive ME, Blazer DG
Epidemiology, Demography and Biometry Program, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892.
OBJECTIVE: To explore the relationship of smoking cessation and depression. DESIGN: Cohort study with 3 years of follow-up. SETTING: North Carolina community of the Established Populations for the Epidemiologic Studies of the Elderly. PARTICIPANTS: Stratified cluster sample of adults age 65 years and older, with an oversampling of African Americans. MAIN MEASURES: Depressive symptoms using a modified Center for Epidemiologic Studies Depression (CES-D) scale; smoking cessation using change in self-reported smoking. RESULTS: Current smokers had the highest prevalence of clinically significant CES-D scores (11.2%), followed by never smokers (9.6%) and former smokers (7.1%). After 3 years, 128 (25%) of 511 baseline current smokers had quit. Among women with a clinically significant CES-D score, 55% quit smoking, compared with only 25% among those with a normal score (P < 0.05). Depressive symptoms were significantly associated with nearly fourfold increased odds of smoking cessation among women (relative odds [RO] 3.7, 95% confidence interval [CI] 1.2, 11.0; P < 0.05), but not among men (RO 0.6, 95% CI 0.2, 2.0, not significant), after adjusting for potential confounding. CONCLUSIONS: Depressive symptoms may directly increase the likelihood of smoking cessation among older women. When predicting smoking cessation, depression and gender should be considered in combination since to consider them separately may be misleading. This challenges prior reports that depressed smokers are less likely to quit smoking than nondepressed smokers.
PMID: 8227913, UI: 94044371

            J Consult Clin Psychol 1999 Aug;67(4):547-54

Antidepressant pharmacotherapy helps some cigarette smokers more than others.
Hitsman B, Pingitore R, Spring B, Mahableshwarkar A, Mizes JS, Segraves KA, Kristeller JL, Xu W
Department of Psychology, Finch University of Health Sciences/Chicago Medical School, Illinois, USA.
Adult smokers (N = 253) without clinically significant depression were randomized on a double-blind basis to receive fluoxetine (30 or 60 mg daily) or a placebo for 10 weeks in combination with cognitive-behavioral therapy (CBT). It was predicted that fluoxetine would selectively benefit smokers with higher baseline depression, nicotine dependence, and weight concern and lower self-efficacy about quitting smoking. Among those who completed the prescribed treatment regimen, baseline depression scores moderated the treatment response. Logistic regression analyses showed that 1 and 3 months after the quit date, fluoxetine increased the likelihood of abstinence, as compared with placebo, among smokers with minor depression but not among those with little or no depression. Results suggests that, as an adjunct to CBT, fluoxetine enhances cessation by selectively benefiting medication-compliant smokers who display even subclinical levels of depression.
Publication Types: Clinical trial , Randomized controlled trial  PMID: 10450625, UI: 99379119

            J Consult Clin Psychol 1996 Aug;64(4):791-8

Depression and smoking cessation: characteristics of depressed smokers and effects of nicotine replacement.
Kinnunen T, Doherty K, Militello FS, Garvey AJ
Department of Oral Health and Epidemiology, School of Dental Medicine, Harvard University, Boston, Massachusetts, USA. kinnunen@neu.edu
Previous research has linked depression to difficulties in smoking cessation. The authors followed 269 smokers who attempted to quit smoking for 3 months. Participants were given nicotine gum (2 or 4 mg) or placebo gum and brief counseling. The study found that 34% of the smokers met the criterion for current depression using the Center for Epidemiological Studies Depression Scale. Depressed smokers relapsed significantly earlier than the nondepressed. Nicotine gum was significantly more effective than placebo gum among all smokers. The benefits of nicotine gum were particularly apparent among the depressed. Only 12.5% of depressed smokers quit successfully with placebo gum for 3 months, whereas 29.5% quit with nicotine gum. Depressed smokers reported more stress, less coping resources, more physical and psychological symptoms, and more frequent smoking in the presence of negative affect than did the nondepressed.
Publication Types:  Clinical trial , Controlled clinical trial  PMID: 8803370, UI: 96396249

            Prev Med 1999 Jan;28(1):28-32

Smoking cravings are reduced by self-massage.
Hernandez-Reif M, Field T, Hart S
Touch Research Institute, University of Miami, School of Medicine, Florida 33101, USA.
BACKGROUND: Attempts at smoking cessation have been correlated with severe withdrawal symptoms, including intense cigarette cravings, anxiety, and depressed mood. Massage therapy has been shown to reduce anxiety and stress hormones and improve mood. METHOD: Twenty adult smokers (M age = 32.6) were randomly assigned to a self-massage treatment or a control group. The treatment group was taught to conduct a hand or ear self-massage during three cravings a day for 1 month. RESULTS: Self-reports revealed lower anxiety scores, improved mood, and fewer withdrawal symptoms. In addition, the self-massage group smoked fewer cigarettes per day by the last week of the study. CONCLUSIONS: The present findings suggest that self-massage may be an effective adjunct treatment for adults attempting smoking cessation to alleviate smoking-related anxiety, reduce cravings and withdrawal symptoms, improve mood, and reduce the number of cigarettes smoked.
Publication Types:  Clinical trial , Randomized controlled trial   PMID: 9973585, UI: 99139774

            Addict Behav 1997 Nov-Dec;22(6):783-7

The relationship between a history of depression and adherence to a multicomponent smoking-cessation program.
Ginsberg JP, Klesges RC, Johnson KC, Eck LH, Meyers AW, Winders SA
Department of Psychology, University of Memphis, TN, USA.
The purpose of this study was to determine whether a history of depression in female smokers (age 18-65) who did not self-report any current depression was associated with adherence to a multisession, multicomponent smoking-cessation program. Participants in a 13-week cognitive-behavioral group program plus random assignment to nicotine gum, appetite suppressant gum, or placebo chewing gum were grouped by depressive-history and compared on attendance, average expired carbon monoxide after planned cessation, and number of pieces of gum chewed. No significant differences between the depressive history (yes/no) subgroups were found on any of the three measures of adherence. The power to detect a significant difference (alpha = 0.05) was calculated to be 0.89. Group cognitive-behavioral treatment appears to be the basis of an effective smoking-cessation program for women with a history of depression who are not currently depressed.  PMID: 9426796, UI: 98088202

            J Consult Clin Psychol 1993 Oct;61(5):761-7

Nicotine, negative affect, and depression.
Hall SM, Munoz RF, Reus VI, Sees KL
Department of Psychiatry, University of California, San Francisco.
Depression, whether conceptualized as a trait, symptom, or as a diagnosable disorder, is overrepresented among smokers. Depressed smokers appear to experience more withdrawal symptoms on quitting, are less likely to be successful at quitting, and are more likely to relapse. This article documents these relationships and explores several potential links between smoking and depression. The potential efficacy of antidepressant therapy, cognitive-behavioral therapy, and nicotine replacement therapy for smokers with depressive disorders or traits is discussed. Clinical implications and the role of patient treatment matching are also discussed.
Publication Types:  Review , Review, tutorial MID: 7902368, UI: 94064966

            Am J Prev Med 1996 Sep-Oct;12(5):378-87

The impact of depression on smoking cessation in women.
Borrelli B, Bock B, King T, Pinto B, Marcus BH
Miriam Hospital, Division of Behavioral and Preventive Medicine, Brown University School of Medicine, Providence, RI 02906, USA. Borrelli@brownvm.brown.edu
INTRODUCTION: Cigarette smoking poses unique, but preventable health risks to women. Identification of barriers to womens' quitting is essential to tailor interventions accordingly. Major depression, whether historical, current, or subsyndromal, may present unique challenges to women quitting smoking. Although several reviews discuss women and smoking in general, this review focuses exclusively on the role of depression in womens' smoking. OBJECTIVES: The goals of this review are to (1) discuss and synthesize the current findings on the association between smoking and depression in women in general, and in particular subgroups of women (underserved, premenstrual, postpartum, menopausal), (2) discuss physician-assisted, pharmacologic, behavioral interventions for mood management, and (3) propose future avenues for intervention, research, and policy. IMPACT OF DEPRESSION: Major depression may influence smoking cessation in women because (1) depression is twice as common among women as men, (2) history of depression and negative affect have been associated with smoking treatment failure, (3) quitting smoking is especially difficult during certain phases of the reproductive cycle, phases that have also been associated with greater levels of dysphoria, and (4) subgroups of women who have a high risk of continuing to smoke (underserved, less educated, low SES) also have a high risk of developing depression. CONCLUSIONS: Since many women who are depressed (or who have developed depression during prior quit attempts) may be less likely to seek formal cessation treatment, practitioners have a unique opportunity to persuade their patients to quit. We discuss patient-treatment matching.
Publication Types:  Review , Review, tutorial  PMID: 8909649, UI: 97066168

            J Consult Clin Psychol 1996 Oct;64(5):1060-7

Interactive effects of depression symptoms, nicotine dependence, and weight change on late smoking relapse.
Killen JD, Fortmann SP, Kraemer HC, Varady AN, Davis L, Newman B
Center for Research in Disease Prevention, Stanford University School of Medicine, California 94304, USA. Killen@scrdp.stanford.edu
Signal detection methods were used to develop an algorithm useful in distinguishing those at risk for late relapse from those likely to maintain abstinence. Four subgroups with 24-month survival (nonrelapse) rates ranging from 79% to 33% were identified. Among participants whose depression symptoms decreased from baseline to the end of treatment, lower levels of nicotine dependence were associated with less relapse at the 24-month follow-up (odds ratio = 2.77; 95% confidence interval: 1.36-5.62). Among participants whose depression symptoms increased from baseline to the end of treatment, greater weight gain was associated with less relapse at follow-up (odds ratio = 2.90; 95% confidence interval: 1.41-5.96). This study suggested that it may become possible to use both baseline and treatment information to "titrate" interventions.
Publication Types: Clinical trial , Randomized controlled trial PMID: 8916636, UI: 97074088

            Health Rep 1998 Spring;9(4):39-46(Eng); 39-48(Fre)

Age of smoking initiation: implications for quitting.
Chen J, Millar WJ
Health Statistics Division, Statistics Canada, Ottawa.
OBJECTIVES: The effect of an early age of smoking initiation on cigarette consumption and on the probability of quitting is analyzed for people aged 21 to 39. DATA SOURCE: The data are from Statistics Canada's 1994/95 National Population Health Survey. The findings in this article are based on 3,449 randomly selected respondents aged 21 to 39 who were or had ever been daily smokers. ANALYTICAL TECHNIQUES: Logistic regression was used to analyze the association between age of smoking initiation and heavy cigarette consumption (more than 20 a day). Survival analysis techniques were used to study the relationship between age of smoking initiation and smoking cessation for men and women. Cox proportional hazard models were used to control for potential confounding factors such as education, household income, depression, chronic stress, self-esteem, and amount smoked. MAIN RESULTS: Among 21- to 39-year-olds, smoking initiation during early adolescence was associated with greater daily cigarette consumption and a lower cumulative probability of quitting. PMID: 9836879, UI: 98255059

             J Natl Cancer Inst 1997 Dec 17;89(24):1852-67

Tobacco addiction: implications for treatment and cancer prevention.
Cinciripini PM, Hecht SS, Henningfield JE, Manley MW, Kramer BS
The University of Texas M. D. Anderson Cancer Center, Houston 77302, USA. pcinciri@notes.mdacc.tmc.edu
The American Society of Clinical Oncology and the National Cancer Institute convened a symposium in June 1996 on tobacco addiction. Additional support for the symposium was provided by the American Medical Women's Association and the American Society of Preventive Oncology. The goals of this conference were to describe the burden and public health consequences of tobacco addiction, to describe the state of science for the treatment of nicotine dependence, and to explore new strategies to increase quit rates and to prevent the uptake of tobacco use. This article summarizes and integrates the meeting presentations on tobacco addiction and includes the topics of smoking prevalence; psychobiologic aspects of nicotine dependence; and implications for disease, treatment, and prevention. Comments on regulatory approaches and national strategies for reducing dependence are also summarized in presentations by Dr. David Kessler, former Food and Drug Administration Commissioner, and Dr. C. Everett Koop, former U.S. Surgeon General.
Publication Types: Review , Review, tutorial PMID: 9414173, UI: 98074984

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