Determinants of attrition from cessation treatment in smokers with a history of major depressive disorder.

Abstract

Attrition from smoking cessation treatment by individuals with a history of major depression was investigated. An investigation of preinclusion attrition examined differences between eligible smokers who did (n = 258) and did not (n = 100) attend an initial assessment session. Postinclusion attrition was investigated by comparing early dropouts (n = 33), lale dropouts (n = 27), and treatment completers (n = 117). Those who failed to attend the assessment session were more likely to be female, to smoke cigarettes with higher nicotine content, and to have a history of psychotropic medication use. Early-treatment dropouts reported a higher smoking rate than late-treatment dropouts and endorsed more symptoms of depression than late dropouts and treatment completers. Results are compared with previous investigations of smoking cessation attrition, and implications for treatment and attrition prevention are discussed.Attrition from treatment poses a considerable problem for both researchers evaluating interventions (Howard, Cox, & Saunders, 1990) and clinicians delivering treatment (Stark, 1992). In studying attrition, investigators have found it useful to distinguish between preinclusion attrition-which occurs prior to entering a study, during screening or during intake evaluations-and postinclusion attrition, which occurs during treatment or posttreatment follow-ups (Howard et al., 1990). For example, evaluations of smoking cessation programs have noted preinclusion attrition rates of 30%-50% (Curry, Marlatt, Gordon, & Baer, 1988;Kviz, Crittenden, Madura, & Warnecke, 1994;Hall, Muñoz, & Reus, 1994) and postinclusion attrition rates that range from less than 10% (Curry, Thompson, Sexton, & Omenn, 1989;Zelman, Brandon, Jorenby, & Baker, 1992) to approximately 50% (Curry et al., 1988;Klesges et al., 1988).Although they are significant, these rates of attrition may be even higher in selected high-risk groups of smokers, such as those with psychiatric comorbidity. Disproportionately high rates of psychiatric comorbidity with cigarette smoking have been found in both adolescent (Brown, Lewinsohn, Seeley, & Wagner, 1996) and adult ) community samples. In adult smoking cessation programs, rates of past major depressive disorder (MDD) have ranged from 31% (Hall et al., 1994) to 61% (Glassman et al., 1988 smokers with a history of major depression have been shown to have elevated negative mood at pretreatment (Ginsberg, Hall, Reus, & Muñoz, 1995;Hall et al., 1994), to experience mood disturbance following cessation Ginsberg et al., 1995), and to relapse at higher rates than smokers without past MDD (Glassman et al., 1988;Glassman, 1993).As the overall prevalence of cigarette smoking decreases (Centers for Disease Control, 1994), those remaining smokers are likely to have more difficulty quitting because of factors such as psychiatric comorbidity and high nicotine dependence (Coambes, Kozlowski, & Ferrence, 1989;Hughes, 1993). Smoking cessation programs are increasingly faced with the prospect of delivering treatment ...

Exercise as an adjunct to nicotine gum in treating tobacco dependence among women

“…At the end of the one-year follow-up, the abstinence rates were 9.8%, 12.5% and 5.9%, respectively. Over the past several years, researchers have observed that the remaining smokers in the population are primarily heavily addicted, long-term users (Curtin, Brown, & Sales, 2000;Hughes & Brennan, 1996), who are resistant to current treatments (Irvin & Brandon, 2000;Irvin, Hendricks & Brandon, 2003). The rates of relapse in our study appeared to follow the same trend that these researchers have described.…”

Predictors of attendance and dropout at the Lung Health Study 11-year follow-up

“…A more recent randomized multicenter trial that matched treatment protocol with particular patient types found much lower attrition rates, with 87% of participants attending a three-year follow-up evaluation [2]. Regarding smoking cessation, older, heavier smokers were more likely to participate but less likely to abstain [3].…”

“…Some predictors of attendance at follow-up evaluations have emerged in the literature, but again, there is a lack of consistency, in part, due to the extreme heterogeneity of participants across studies. Predictors of increased attrition include previous treatment for psychiatric or emotional problems, slower initiation of participant into a treatment program after randomization [2], depressed mood [3,4], and failure to complete at least one treatment session [5]. Attrition appears lowest when the research area is of personal interest to participants [6].…”

Predictors of Participation in a Smoking Cessation Program among Young Adult Smokers

“…Therefore, it is unclear what factors influence the likelihood that a young adult smoker would participate in a formal smoking cessation program. Prior research in older adults suggests a host of factors (e.g., demographic, smoking history, social, and psychological) may contribute to nonparticipation in smoking cessation programs (8)(9)(10)(11)(12). These factors include gender, race, education, smoking rate, and depressive symptoms.…”