Tool measures relapse risk when giving up cigarettes
Tool measures relapse risk when giving up cigarettes
Addressing risk factors can result in greater success
Why are some smokers successful when they give up cigarettes and others unable to quit? It has to do with risk of relapse, according to researchers at the University of Wisconsin Center for Tobacco Research and Intervention in Madison, which is part of the university's School of Medicine and Public Health.
Smokers who better understand what puts them at risk for relapse can address the issues in advance and as a result have a greater chance of success, says Megan Piper, PhD, one of the researchers at the University of Wisconsin School of Medicine and Public Health.
Many smokers believe that willpower determines whether they will be able to quit smoking, and they don't think about using any kind of medication, counseling, or assistance, says Piper. "They think they should just be able to quit, because smoking is a nasty habit. They don't think of it as an addiction," she explains.
To help smokers get a better perspective about their risk for relapse and reasons why it might occur, Piper and other researchers at the Center for Tobacco Research and Intervention created a seven-question survey called WI-PREPARE (Wisconsin Predicting Patient's Relapse). They expect it to help smokers learn that both environment and degree of addiction impact attempts to quit. It also will help clinicians tailor treatment to a particular individual.
The survey questions were formed from a more comprehensive measure of tobacco dependence created at the Center for Tobacco Research and Intervention. The survey developers took an actuarial approach, according to Piper, and looked at which items from the more in-depth measure performed best and whether each item in the survey added something new.
If two items asked about how much a person smoked, the survey developers determined which question was better.
The seven-question survey gathers information on the following issues:
Whether people in a household have to go outside to smoke.
Whether a smoker's workplace has a no-smoking policy or designated smoking areas.
Whether a person is around smokers a lot of the time.
Whether cravings become intolerable if a smoker has not been able to have a cigarette for a few hours.
How quickly a person has to have his or her first cigarette when they get out of bed in the morning.
The number of cigarettes smoked each day.
The highest grade or year of school a smoker completed.
Data shapes individual plan
"We don't know exactly which treatments to give people at this point, based on this questionnaire. We are doing that research now, but you can speculate as to how things might happen," says Piper.
For example, if a person has a cigarette about five minutes after getting up in the morning, it would suggest his or her body really needs nicotine after being without it all night, and therefore, a 24-hour nicotine patch may be an appropriate treatment. It also would suggest a high level of dependence, so two nicotine replacement therapies might be appropriate, such as a patch in combination with an inhaler or nasal spray, says Piper.
Smokers can use the information on the survey to work out a plan with the help of their clinician. For example, they might need to determine how to fit into their social group if smoking is prevalent. That may mean initially avoiding social situations in which they and their friends smoke. They can seek support from the nonsmokers in their environment and ask smokers not to offer them cigarettes.
Giving up cigarettes is more than a health behavior change because of the addiction component, says Piper. There are differences in the addiction that make it more difficult for one person to quit than another, she adds.
People need to understand that if they live in a household where everyone smokes, it will be more difficult to quit, because cigarettes are everywhere. When they have an urge for a cigarette, they can easily pick one up and light it. A greater understanding of their risk for relapse helps smokers identify what is making it difficult for them to quit.
The question about education is included in the survey, because more and more research in the United States and Europe is showing a divide along socioeconomic lines, says Piper. People in a lower socioeconomic group are more likely to smoke, she says. There could be many reasons why. She says some research suggests they may have more chronic stressors, such as financial difficulties, that prompt them to smoke and fewer opportunities to get medications to help them quit.
Knowledge about risk for relapse also helps smokers identify the need for a plan. For example, when cravings become intolerable, how will they deal with them? For example, will they chew nicotine gum or regular gum or go for a walk? People can determine ways to get through situations such as strong cravings. This approach includes putting a plan in place to address the issues when they arise and a plan to avoid them at least in the beginning, says Piper.
SOURCE
For more information about the seven-question survey to assess a person's likelihood of relapse when trying to quit smoking, contact:
Megan Piper, PhD, University of Wisconsin Center for Tobacco Research and Intervention, 1930 Monroe, Suite 200, Madison, WI 53711. Telephone: (608) 262-8673.
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