PURPOSE: There is a belief that various stress factors adversely affect the quitting process. We examined the impact of stressful events in a cohort of smokers being treated for tobacco dependence.
METHODS: Questionnaires on day-1 elicited self-reported information on: medical history, current medication use, obstacles to quitting, current major stressors (see categories below), tobacco-related habits, past quit attempts. Behavior modification and pharmacotherapy were utilized. At 30-day mark, quit status was validated using a (Bedfont® hand-held) carbon monoxide monitor. One-year f/u for quit status was done. Institutional Review Board approval was obtained. Data analyzed using SAS®.
RESULTS: 41% (n=549) of 1330 smokers experienced one or more Major Stressful Events during treatment. Stressed Smokers were more likely than Non-Stressed Smokers to ‘light up when upset” 90% vs.79% (p<0.0001), ‘smoke when I want to take my mind off worries’ 68% vs. 54% (p< 0.0001), ‘ smoke when I feel uncomfortable’ 90% vs. 79% (p<0.0001). Stressed smokers were also more likely to report: ‘worried about managing cravings without cigarettes’ 49% vs. 31% (p<0.0001), worried about managing stress without cigarettes 63% vs. 42% (p<0.0001). At 30-day mark, 50% of stressed smokers (OR=0.7, p<0.005) vs. 60% of non-stressed smokers quit smoking (p<0.0001) yet at 1-year mark there were no differences (35%) in quit success. There were significant differences in quit success by stressor: 43% who cited ‘Change in marital status’ (p<0.01); 38% who cited ‘Change in job’ (p<0.0002); 35% who cited ‘Geographical move’ (p<0.005). No change in categories: ’loss of important relationship’, ’recent death of a loved one’, ’important legal problems’, ’major health problems’.
CONCLUSION: Many smokers who reported major stressful events during treatment process were able to quit. Stressful life events should not be considered an obstacle to quitting. We believe that utilizing behavioral modification as an adjunct to pharmacotherapy can improve quit success.
CLINICAL IMPLICATIONS: Successful tobacco dependence treatment programs that incorporate behavioral modification (with effective stress management techniques) along with FDA approved pharmacotherapy can maximize quit rates despite patients perceived stress.
DISCLOSURE: Virginia Reichert, None.