Smoking Cessation Study

Smoking Cessation: Literature Review

Introduction

Global statistics on smoking depict a worrying trend irrespective of the health risks associated with the act. The World Health Organization estimates that approximately 1.35 billion people smoke, which translates to about 20% of the global population. Furthermore, the WHO reports that about 33% of the male population globally use tobacco, and tobacco-related deaths are taking place after every eight seconds, which could be associated with lung cancer, asthma, bronchitis, heart attacks, mouth cancer and other tobacco-related diseases. At the current situation where cigarette sales are clocking 5 trillion, it is highly likely smoking will remain the biggest killer at the global level. Amidst this worrying statistics, a fact that stands out is that smoking behaviour and subsequent addiction is a matter of choice, which poses the need to devise effective strategies to help curb smoking. This literature review places emphasis on smoking cessation and the best treatment strategies available to quit smoking among young adult. The theoretical framework adopted in this literature review is to assess the most effective strategy in smoking cessation is social learning theory, which draws on the assumption that smoking is a behavior that is learned; therefore, it can be unlearned. The review also outlines the methodology, results of the study and personal opinion towards the study.

Research Problem

            The primary purpose of this review of literature is to evaluate the best treatment strategies that are available to help young adults quit smoking. There are a number of smoking cessation strategies that can be deployed by young adults; however, this literature review places emphasis on evaluating the best existing strategies, in particular, using social learning theory to come up with an effective treatment strategy.

Aim

            The primary purpose of this manuscript is to undertake a review on published research relating to smoking cessation. This paper also aims at providing young individuals with information needed to quit smoking successfully. The literature review provides relevant information to health workers regarding the best treatment options that are available to facilitate smoking cessation.

Research Hypothesis

H1: Smoking behavior is learned; therefore, it can be learned

H2: cognitive-behavioral treatment strategies can be implemented to facilitate effective smoking cessation

Theoretical Framework

The theoretical framework deployed in smoking cessation is social learning theory, which draws on the assumption that smoking is a behavior that is learned; therefore, it can be unlearned. This paper makes use of social learning theory as a lens to have an insight towards smoking behavior among individuals. Social learning theory has become an undoubtedly become an influential theory with regard to learning and development. In particular, this study utilizes the social learning theory suggested by Alan Bandura (1977). According to Bandura (1977), direct reinforcement does not take into account all forms of learning. His theory of learning incorporated a social element, which draws on the assumption people usually learn behaviors through watching other people. Referred to as observational learning, this form of learning is usually deployed in studying various behaviors. Social learning theory concedes that, “birds of the same feather flock together; therefore, they influence one another’s behavior in both deviant and conforming behaviors. As a result, cognitive-behavioral measures can be deployed effectively in smoking cessation. These measures draw on social learning theory, which perceives smoking cessation as a process whereby an individual breaks all situational and emotional ties associated with smoking behaviors. To stop smoking, the quitting smoker must have an understanding of the addiction process and the conditioned responses associated with smoking when tackling symptoms of withdrawal and craving. Core elements of social learning theory in smoking cessation entail motivational interviewing (MI) and cognitive-behavioral Therapy (CBT). Under MI, the health worker can assist quitting smokers to resolve ambivalence and empower them to choose change. Under CBT, health workers can assist quitting smokers to undertake new, alter thoughts, which can be helpful in implementing a solid quitting and relapse prevention plan

Review of Literature

            A number of studies have been undertaken to determine the most effective treatment strategies for help people quit smoking behaviour. Studies have reported that most young individuals fail in their attempts to quit smoking, although the failure is not associated to lack of trying. A number of studies point out that at least 66% of young smokers want to cease smoking; in fact, most young individual have reported that have tried to quit smoking. O’Connor et al. (2008) found out that most attempts by adolescents to quit smoking failed because they lacked assistance. O’Connor et al. (2008) estimated a relapse rate of about 90-95%. Young individuals who attempted to quit smoking with the aid of cessation programs were better than their counterparts who failed to utilize assistance; however, the relapse rates were still considerably high, which was about 88% after 3 to 6 months after treatment. The implication from this observation is that the identification of treatments that are successful in increasing cessation among teenagers is a critical issue. Backinger et al. (2008) outlined a number of smoking cessation interventions for young individuals; they include pharmacotherapy, behavioural interventions and tobacco control policies, all of which have reported mixed results regarding the success of cessation.

A large percentage of randomised cessation trails with young smokers have focused mainly on psychosocial interventions. Until recently, trials focusing on the success of pharmacotherapy have commenced to appear on existing literature. In comparison with research on other smoking cessation treatments, such as adolescent psychosocial treatment, adult pharmacotherapy and psychosocial treatment, it is apparent that the amount research committed to evaluating the effectiveness of pharmacotherapy is minimal. In addition, the small amounts of studies vary significantly with respect to the dose and type of pharmacotherapy evaluated, attributes of the sample population, and the research design. Furthermore, the findings from these studies have been disappointing. According to the dismal state of literature on pharmacotherapy interventions, the existing clinical practise guideline report that there is no adequate evidence to conclude that pharmacotherapy is the best treatment for helping smoking cessation among young adults. Instead, the clinical practise guidelines suggest the use of suitable psychosocial interventions in the form of individual counselling, community based and school based interventions as the first line treatment for young adult smokers.

With regard to psychotherapy interventions, there is the difficulty in attributing post-treatment abstinence to the medication being evaluated; this is because most studies lacked placebo control. In addition, there is the difficulty in disentangling effects of medication from the background treatment. Furthermore, young adults have a tendency of using the medication at low levels. The average quit rates of pharmacotherapy treatment after follow up usually fall below those achieved in psychosocial interventions with adolescents. This is because psychosocial interventions have added benefits in the sense that they incorporate a wider diversity of young smokers and have better intervention retention than pharmacotherapy studies. Besides, young smokers taking part in pharmacotherapy trials tend to smoke frequently are rely more on nicotine than young adults selected for psychosocial trials; therefore, there is the probability that direct comparisons of cessation rates may be misleading. O’Connor et al. (2008) points out that heavier smoking young adults have a myriad of mental and psychosocial issues when compared to lighter smoking young adults, which impose significant constraints on treatment completion and attaining abstinence in the long term. As a result, there is the need to evaluate the results of pharmacotherapy trials with respect to the population receiving the treatment. The quit rates of young adults in pharmacotherapy studies are below the quit rates of adults. Factors contributing to this trend include difficulties in the recruitment, retaining and acquiring the consent of the participants. Therefore, well-designed studies are likely to underpowered statistically and fail to recognize the medium effects of medication. Furthermore, there is poor compliance regarding medication, which imposes significant limits on the ability of the researcher to assess the actual effects of medication. The third limitation in pharmacotherapy trials of young adults is the inaccuracy of self-report. O’Connor et al. (2008) points out that even if adolescent pharmacotherapy trials achieve sufficient trials, verification and medication compliance, pharmacotherapy for adults may not be well effective for the case of adolescents. Pharmacotherapy interventions among young adults are constrained by the fact that adolescents have high levels of emotional reactivity and reward sensitivity. In addition, young adults face the challenge of regulating their individual behaviour. According to Backinger et al. (2008), the mechanisms influencing the smoking behaviour may not be similar for young and mature adults. Various studies have pointed out that daily smokers have less intense symptoms associated with nicotine dependence than mature adults do. In the event that smoking behaviour among young adults is motivated less by internal variables like nicotine reliance and more by external variables like family members and peers, then the effectiveness of pharmacotherapy treatment is reduced among young adults (Czarnecki et al. 2010)

A study by Czarnecki et al. (2010) reported that the experience associated smoking abstinence among young adults is likely to be different from the experience of mature adults. Both young and mature adults experience similar withdrawal symptoms; however, it is unclear the level to which withdrawal symptoms affect smoking relapse. In the event, there is no close association between relapse in young adults, the effectiveness of pharmacotherapy in teenagers is limited. Czarnecki et al. (2010) concludes that there is inadequate evidence to sum up that pharmacotherapy is effective in assisting smoking cessation among young adults. O’Connor suggests that pharmacotherapy interventions required close follow up and taking into account the smoking rate of the patient, and the motivating factors towards the smoking behaviour.

The burden on public health associated with young adult smoking has facilitated numerous evaluations on smoking cessation programs. Current reviews take a difference stance, contrary to the aforementioned approach, that there is adequate evidence that suggests that behavioural-based programs are effective in helping young adults to stop smoking. Sun and Dent initiated a meta-analysis of smoking cessation programs for young adults. The authors utilized electronic databases, published and unpublished research for the years 1970-2003, which included 48 quasi-experimental and experimental researches that drew upon a myriad of behavioural interventions for the analysis. The study reported that cessation programs provided smokers with an absolute advantage of 2.9% and increased the likelihood of smoking cessation by 46%. The authors also reported that group-based behavioural interventions were the most effective, with examples including Project EX and Not on Tobacco (NOT) program. A myriad of theoretical strategies that can be deployed in behaviourally based interventions including cognitive behavioural therapy, motivational instruction and medical approaches. In addition, social influence strategies have been formulated in an attempt to address the social variables that led to the development of smoking behaviour among individuals. Cognitive behavioural strategies attempt to tackles issues associated the young adult’s smoking behaviours, such as reasons for smoking, smoking triggers and self-monitoring. In addition, cognitive behavioural measures offer young adults with the guidance required to manage cravings and urges effectively, live healthy lifestyles, and manage difficulties in quitting. Motivational interviews focus in highlighting the benefits of embracing smoke-free behaviour. This approach draws on the assumption that the responsibility for smoking cessation is within the patient, and the interventionist or health worker serves to create suitable conditions that encourage motivation and build confidence to change. Motivational interviews are helpful in adding a young smoker who is undecided about quitting smoking. Medical approaches entail the use of pharmacological appendages to aid recovery. Irrespective of the fact that there is no universal theory to inform young adults of smoking cessation, numerous epidemiological researches have investigated and outlined the core psychosocial predictors of quitting smoking, which include frequency of smoking, the degree of nicotine reliance, peers and family members engaging in smoking behaviour, and smoking history. Studies have suggested smoking cessation interventions based on cognitive behavioural theories and contingency management theories are the most effective. Studies have also affirmed that there is a positive correlation between program intensity and effectiveness, wherein effective interventions have more than five sessions. The most effective smoking cessation treatments for young adults are clinics and school classrooms.

Methodology

            This literature review embarked on reviewing published studies on smoking intervention strategies. This required the use of national and international databases for journal articles and manuscripts related to the use of tobacco. These databases were investigated for relevant material that related to the primary emphasis of this literature review. Nevertheless, most of the studies reviewed were sourced independently, with all retrieved literature comprising of peer reviewed journal articles that have been published online. Other articles were sourced through individual research discussions with health professionals. The literature search generated about 40 papers that were relevant to the focus of this research. Out of these, only 8 sources were selected for review. The databases used for the literature search included Pub Med, Sage Pub, Web of Science, and Google Scholar.

There were a number of search terms used together with inclusion and exclusion criteria. The inclusion criteria included “smoking cessation strategies among young adults” OR “smoking cessation interventions”. The exclusion criteria eliminated journal articles and empirical reviews undertaken before 2007. In addition, studies that placed emphasis on explaining smoking behaviours were excluded; instead, the search focused on studies that evaluated the effectiveness of intervention strategies.

With regard to the quality of research, the paper included both quantitative and qualitative research in order to offer a wide perspective regarding the research topic. Qualitative studies included randomised trials to determine the effectiveness of pharmacotherapy intervention and behaviourally based interventions. Qualitative studies entailed interviews with health workers and participants of the smoking cessation programs.

Results of the Study

            The study concludes that there is adequate evidence to suggest that behavioural-based interventions are the most effective in aiding smoking cessation among young adults. The paper has pointed out that the effectiveness of a smoking cessation intervention depends on the triggers of external behaviour; for instance, external triggers are best tackled using behavioural interventions whereas internal triggers like nicotine dependence are addressed effectively using pharmacotherapy. Therefore, there is the need to have an understanding of the variables affecting the smoking behaviour of young adults in order to develop an effective smoking cessation strategy. The study has pointed out that behavioural-based interventions are more effective than pharmacotherapy interventions in ensuring smoking cessation among young adults. Cognitive behavioural approaches can be applied for young smokers requesting assistance to quit smoking. Behavioural strategies draw on the social learning theory, wherein smoking cessation entails the smoker breaking situational and emotional ties formed with smoking. There is the need for the smoker to have an understanding of the addiction process and the conditioned responses when addressing craving and withdrawal symptoms. After this, the health worker has the responsible of providing a suitable environment that favours smoking cessation using motivational interviews.