The A-B-C's of Smoking Cessation: Using Behavioral Strategies to Help Undergraduates Stop Smoking

Cole, Matthew L., Bonem, Marilyn K., The Behavior Analyst Today

Abstract

Despite reports claiming cigarette smoking remains the most preventable cause of premature death in the United States, cigarette use by college students is increasing on campuses nationwide. We investigated the effectiveness of a brief multicomponent smoking cessation program provided for a 21- year-old female (Sue) and an 18-year-old male (Tom) undergraduate student from a midwestern university. The treatment program consisted of self-report functional assessment methodology, schedule-reduced smoking, and functionally derived self-management strategies. The use of a functional assessment device provided descriptions of antecedent-behavior-consequence relationships, thereby engendering idiographic self-management cessation strategies, and a schedule-reduced smoking component was included in order to facilitate the programmed reduction in nicotine intake. Dependent measures included self-report of daily smoking frequency and alveolar carbon monoxide levels. Treatment included four weekly sessions lasting approximately 45 minutes. Though neither participant achieved complete cessation, Sue achieved a 70% reduction in smoking at 6-months follow-up. Tom achieved a 60% reduction in smoking at 14-day follow-up, but reported returning to above pre-treatment smoking frequency at 6-months follow-up. Treating college smokers with a rapid multicomponent program targeting the both the behavioral and pharmacological aspects of smoking behavior may offer reductions in smoking.

**********

Approximately one quarter of U.S. adults are regular users of tobacco (U.S. Department of Health and Human Services, 1996). Despite reports that claim cigarette smoking remains the most preventable cause of premature death in the United States (U.S. Department of Health and Human Services, 1989), cigarette use by college students is increasing on campuses nationwide (Wechsler, Rigotti, Gledhill-Hoyt, 1998). In a recent sample of college students in California who were less than 24-years-old, 20.3% reported smoking cigarettes (Patrick, Covin, Fulop, Calfas, & Lovato, 1997). Of those, 14.3% reported smoking for the first time in college and 44.3% had tried to quit smoking during the previous six months but had failed. Considering the health risks attributable to smoking, smoking cessation programs play an important role in public healthcare because they can be designed to target high-risk groups, such as college students, or those with the highest risk for the dose-dependent morbidity and mortality associated with cigarette smoking (Fiore et al., 1990).

A variety of methods used to help tobacco smokers achieve and maintain cessation have been evaluated in several studies and may be divided into several categories. These include behavioral methods (e.g., self-control and aversion techniques), pharmacological methods (e.g., nicotine replacement therapy), self-help approaches (e.g., Freedom From Smoking in 20 Days, American Lung Association, 1984), hypnosis, acupuncture, mass media and community programs and multicomponent techniques (e.g., behavioral and pharmacological methods)(Glasgow & Lichtenstein, 1987; Pechacek, 1979; Schwartz, 1987; Skaar et al., 1997). Typical cessation rates range from approximately 15-20 %, and treatments that target both the psychological and pharmacological aspects of smoking behavior (i.e., multicomponent techniques) produce higher abstinence rates than those that do not (Cinciripini et al., 1994). For example, Killen, Maccoby, and Taylor (1984) found 50% abstinence rates at 10.5-month follow-up for participants receiving behavioral skills training and nicotine gum. Multicomponent procedures that have been designed to systematically reduce smoking and nicotine intake provide abstinence rates at 1-year follow-up of [greater than or equal to] 40% (e.g., Cinciripini et al., 1994, 1995; Foxx & Brown, 1979). These procedures address the two fundamental components of successful smoking cessation: initial cessation and maintenance.

Initial smoking cessation may involve either a gradual reduction of smoking prior to complete abstinence or abrupt abstinence (Cinciripini et al., 1994). While results from studies evaluating the impact of abrupt versus gradual quitting are equivocal (Schwartz, 1987), Cinciripini et al. (1995) found participants who adhered to a schedule of gradually increasing intercigarette intervals over a 3 week period (i.e., schedule-reduced smoking) had better long-term abstinence at one year follow-up than participants who gradually reduced on their own or stopped abruptly.

Following the initial cessation phase, an individualized maintenance phase should be incorporated into a treatment program (Schwartz, 1987). Designing a maintenance phase tailored to individual smoking patterns requires the therapist to obtain information on potential interdependent functional relationships between the client's smoking and the contextual cues in their environment via functional assessment (Epstein & Collins, 1977). Such a behavioral approach begins with the premise that smoking has multiple predictors and serves multiple functions (Hunt & Azrin, 1973; Sobell, Sobell, & Sheahan, 1976; Sobell, Toneatto, & Sobell, 1994). A self-report functional assessment occurs when a person delivers a thorough verbal report of a target behavior, the context within which it occurs, and a list of hypothesized causal variables (Haynes 1998). The functional assessment can be used to generate a host of self-management interventions customized to address specific functional relations. These interventions can range from stimulus control strategies (e.g., reducing smoking in the presence of, or avoidance of certain events that exert the most control over a target response), to contingency management strategies (e.g., engaging in alternative responses which may serve the same function as the target response).

An underlying assumption of a functional assessment of smoking is that smoking is functional, i.e., it serves a function for the …

Questia, a part of Gale, Cengage Learning. www.questia.com
Publication information: Article title: The A-B-C's of Smoking Cessation: Using Behavioral Strategies to Help Undergraduates Stop Smoking. Contributors: Cole, Matthew L. - Author, Bonem, Marilyn K. - Author. Journal title: The Behavior Analyst Today. Volume: 1. Issue: 4 Publication date: Fall 2000. Page number: 89+. © 2007 Behavior Analyst Online. COPYRIGHT 2000 Gale Group.

This material is protected by copyright and, with the exception of fair use, may not be further copied, distributed or transmitted in any form or by any means.