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
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. …