Abstract
An effective strategy to quit smoking should consider demographic aspects, smoking-related characteristics and psychological factors. This study examined potential predictors of smoking cessation in Spanish college students. A total of 255 college student smokers (18–24 years old), recruited to a cessation trial (Spain, 2013–2014), comprised an observational cohort. The main outcome was biochemically verified (urine cotinine) abstinence at the 6-month follow-up. Baseline potential predictors included socio-demographic, smoking-related and psychological variables (Fagerström Test for Nicotine Dependence (FTND), expired monoxide level (CO), intention to quit, previous quit attempts, participation in previous multicomponent programmes and confidence in quitting). Logistic regression models were used to identify potential predictors, the area under the ROC curve (AUC) was used to discriminate the capacity of the predictors and the Hosmer–Lemeshow goodness-of-fit test was used to assess model calibration. After 6 months of follow-up, variables related to high nicotine dependence, FTND and expired CO levels were associated with lower odds of quitting smoking (OR = 0.69 [95% CI 0.54–0.89] and 0.84 [0.77–0.92], respectively). Furthermore, being prepared to change (OR = 3.98 [1.49–10.64], p = 0.006) and being confident to quit (OR = 4.73 [2.12–10.55], p < 0.001) were also potential predictors of smoking cessation. The model that combined all these variables had the best predictive validity (AUC = 0.84 [0.78–0.91], p = 0.693) and showed good predictive capacity (χ2 = 10.36, p = 0.241). Findings highlight that, in this population of college student smokers, having a lower level of nicotine dependence, being prepared to quit and having the confidence in the ability to quit were associated with smoking cessation, and these factors had good predictive capacity.
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References
Altman, D. G., Vergouwe, Y., Royston, P., & Moons, K. G. (2009). Prognosis and prognostic research: Validating a prognostic model. BMJ, 338, b605. https://doi.org/10.1136/bmj.b605.
Bandura, A. (1998). Self-efficacy: The exercise of control. New-York: Freeman.
Becoña, E., & Vázquez, F. L. (1998). The Fagerström Test for Nicotine Dependence in a Spanish sample. Psychological Reports, 83, 1455–1458 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/?term=The+Fagerstr%C3%B6m+Test+for+Nicotine+Dependence+in+a+Spanish+sample.
Bedfont. (2017). Smokerlyzer® range for use with piCOTM, piCObabyTM and Micro+TM user manual. 2017. Web site. Retrieved from https://www.bedfont.com/file/2494-LAB679%20Smokerlyzer%20Manual%20Issue%203.pdf. Accessed February 26, 2018.
Bernat, D. H., Klein, E. G., & Forster, J. L. (2012). Smoking initiation during adulthood: A longitudinal study of population-based cohort. The Journal of Adolescent Health, 51(5), 497–502. https://doi.org/10.1016/j.jadohealth.2012.02.017.
Bize, R., Burnand, B., Mueller, Y., Rège-Walther, M., Camain, J. Y., & Cornuz, J. (2012). Biomedical risk assessment as an aid for smoking cessation. Ochrane Database of Systematic Reviews, 12, CD004705. https://doi.org/10.1002/14651858.CD004705.pub4.
Bolger, K., Carter, K., Curtin, L., Martz, D. M., Gagnon, S. G., & Michael, K. D. (2010). Motivational interviewing for smoking cessation among college students. Journal of College Student Psychotherapy, 24(2), 116–129. https://doi.org/10.1080/87568220903558661.
Borland, R., Balmford, J., & Benda, P. (2013). Population-level effects of automated smoking cessation help programs: A randomized controlled trial. Addiction, 108(3), 618–628. https://doi.org/10.1111/j.1360-0443.2012.04091.x.
Brown, J. A. (2013). Review of the evidence on technology-based interventions for the treatment of tobacco dependence in college health. Worldviews on Evidence-Based Nursing, 10(3), 150–162. https://doi.org/10.1111/wvn.12000.
Cahill, K., Lancaster, T., & Green, N. (2010). Stage-based interventions for smoking cessation. Cochrane Database of Systematic Reviews, 10, CD004492. https://doi.org/10.1002/14651858.CD004492.pub4.
Cengelli, S., O'Loughlin, J., Lauzon, B., & Cornuz, J. (2012). A systematic review of longitudinal population-based studies on the predictors of smoking cessation in adolescent and young adult smokers. Tobacco Control, 21(3), 355–362. https://doi.org/10.1136/tc.2011.044149.
Centers for Disease Control and Prevention. (2014). Best practices for comprehensive tobacco control programs—2014. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
Diemert, L. M., Bondy, S. J., Brown, K. S., & Manske, S. (2013). Young adult smoking cessation: Predictors of quit attempts and abstinence. American Journal of Public Health, 103(3), 449–453. https://doi.org/10.2105/AJPH.2012.300878.
Haddad, L. G., & Petro-Nustas, W. (2006). Predictors of intention to quit smoking among Jordanian university students. Canadian Journal of Public Health, 97(1), 9–13 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/?term=Predictors+of+intention+to+quit+smoking+among+Jordanian+university+students.
Hayes, E. R., & Plowfield, L. A. (2007). Smoking too young: Students’ decisions about tobacco use. The American Journal of Maternal Child Nurse, 32(2), 112–116 Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/?term=Smoking+too+young%3A+students%27+decisions+about+tobacco+use.
Heatherson, T. F., Kozlowski, L. T., Frecker, R. C., & Fageström, K. L. (1991). The Fagerström Test for Nicotine Dependence: A revision of the Fagerström Tolerance Questionnaire. British Journal of Addiction, 86, 1119–1127 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/?term=The+Fagerstr%C3%B6m+Test+for+Nicotine+Dependence%3A+a+revision+of+the+Fagerstr%C3%B6m+Tolerance+Questionnaire.
Hosmer, D. W., & Lemeshow, S. (2000). Applied logistic regression. Second edition (3rd ed.). New Jersey: John Wiley & Sons, Inc.
Hummel, K., Candel, M. J. J. M., Nagelhout, G. E., Brown, J., van den Putte, B., … de Vries, H. (2018). Construct and predictive validity of three measures of intention to quit smoking: Findings from the International Tobacco Control (ITC) Netherlands Survey. Nicotine and Tobacco Research, 20(9), 1101–1108. https://doi.org/10.1093/ntr/ntx092.
Hyland, A., Li, Q., Bauer, J. E., Giovino, G. A., Steger, C., & Cummings, K. M. (2004). Predictors of cessation in a cohort of current and former smokers followed over 13 years. Nicotine & Tobacco Research, 6(Suppl 3), S363–S369 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/?term=Predictors+of+cessation+in+a+cohort+of+current+and+former+smokers+followed+over+13+years.
Klein, E. G., Forster, J. L., & Erickson, D. J. (2013). Longitudinal predictors of stopping smoking in young adulthood. The Journal of Adolescent Health, 53(3), 363–367. https://doi.org/10.1016/j.jadohealth.2013.04.012.
Kraft, P., Wacholder, S., Cornelis, M.C., Hu, F.B., Hayes, R.B., Thomas, G., … Chanock, S. (2009). Beyond odds ratios-communicating disease risk based on genetic profiles. Nature Reviews Genetics, 10(4), 264–269. doi: https://doi.org/10.1038/nrg2516.
McPherson, S., Packer, R. R., Cameron, J. M., Howell, D. N., & Roll, J. M. (2014). Biochemical marker of use is a better predictor of outcomes than self-report metrics in a contingency management smoking cessation analog study. The American Journal of Addictions, 23(1), 15–20. https://doi.org/10.1111/j.1521-0391.2013.12059.x.
Miller, W. R., & Rollnick, S. (2008). La entrevista Motivacional [Motivational Interviewing]. Barcelona: Ediciones Paidós Ibérica.
Ministry of Education, Culture and Sport. (2016). Datos y Cifras del Sistema Universitario Español. Curso 2015–2016. Retrieved from https://www.mecd.gob.es/dms/mecd/servicios-al-ciudadano-mecd/estadisticas/educacion/universitaria/datos-cifras/datos-y-cifras-SUE-2015-16-web-.pdf. Accessed February, 26.
Pardavila-Belio, M. I., García-Vivar, C., Pimenta, A. M., Canga-Armayor, A., Pueyo-Garrigues, S., & Canga-Armayor, N. (2015). Intervention study for smoking cessation in Spanish college students: Pragmatic randomized controlled trial. Addiction, 110(10), 1676–1683. https://doi.org/10.1111/add.13009.
Pardavila-Belio, M. I., Canga-Armayor, A., Duaso, M. J., Pueyo-Garrigues, S., Pueyo-Garrigues, M., & Canga-Armayor, N. (2019). Understanding how a smoking cessation intervention changes beliefs, self-efficacy and intention to quit. A secondary analysis of a pragmatic randomized controlled trial. Translational Behavioural Medicine, 9(1),58–66. https://doi.org/10.1093/tbm/ibx070.
Peña, P., Zagolin, M., Acuña, M., Navarrete, S., Bustamante, P., & Canals, A. (2016). Factors associated with success of a smoking cessation program. Revista Médica de Chile, 144(8), 965–971 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27905641.
Pencina, M. J., D'Agostino, R. B., D'Agostino, R. B., & Vasan, R. S. (2008). Evaluating the added predictive ability of a new marker: From area under the ROC curve to reclassification and beyond. Statistics in Medicine, 27(2), 157–172 discussion 207–12. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/17569110.
Piñeiro, B., López-Durán, A., Fernández del Río, E., Martínez, Ú., Brandon, T. H., & Becoña, E. (2014). Craving and nicotine withdrawal in a Spanish smoking cessation sample. Adicciones, 26(3), 230–237 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/?term=Craving+and+nicotine+withdrawal+in+a+Spanish+smoking+cessation+sample.
Piper, M. E. (2015). Withdrawal: Expanding a key addiction construct. Nicotine & Tobacco Research, 17(12), 1405–1415. https://doi.org/10.1093/ntr/ntv048.
Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390–395 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/6863699.
Real, J., Forné, C., Roso-Llorach, A., & Martínez-Sánchez, J. M. (2016). Quality reporting of multivariable regression models in observational studies: Review of a representative sample of articles published in biomedical journals. Medicine (Baltimore), 95(20), e3653. https://doi.org/10.1097/MD.0000000000003653.
Riaz, M., Lewis, S., Coleman, T., Aveyard, P., West, R., Naughton, F., & Ussher, M. (2016). Which measures of cigarette dependence are predictors of smoking cessation during pregnancy? Analysis of data from a randomized controlled trial. Addiction, 111(9), 1656–1665. https://doi.org/10.1111/add.13395.
Riemsma, R. P., Pattenden, J., Bridle, C., Sowden, A. J., Mather, L., Watt, I. S., & Walker, A. (2003). Systematic review of the effectiveness of stage based interventions to promote smoking cessation. BMJ, 326, 1175–1177 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/?term=Systematic+review+of+the+effectiveness+of+stage+based+interventions+to+promote+smoking+cessation.
Spanish Observatory of Drugs and Addictions. (2015). Encuesta domiciliaria sobre el consumo de alcohol y drogas en España. Retrieved from http://www.pnsd.msssi.gob.es/profesionales/sistemasInformacion/sistemaInformacion/pdf/2017_Estadisticas_EDADES.pdf. Accessed February 26, 2018.
Spanish Observatory of Drugs and Addictions. (2016). Informe 2016. Alcohol, Tabaco y drogas ilegales en España. Retrieved from http://www.pnsd.msssi.gob.es/profesionales/sistemasInformacion/informesEstadisticas/pdf/2016_INFORME_OEDT.pdf. Accessed February 26, 2018.
Tavolacci, M. P., Ladner, J., Grigioni, S., Richard, L., Villet, H., & Dechelotte, P. (2013). Prevalence and association of perceived stress, substance use and behavioural addictions: A cross-sectional study among university students in France, 2009-2011. BMC Public Health, 13, 724. https://doi.org/10.1186/1471-2458-13-724.
Toljamo, T., Hamari, A., Nieminen, P., & Kinnula, V. L. (2012). Young male daily smokers are nicotine dependent and experience several unsuccessful quit attempts. Scandinavian Journal of Primary Health Care, 30(3), 183–188. https://doi.org/10.3109/02813432.2012.704809.
US Department of Health and Human Services. (2012). Preventing tobacco use among youth and young adults: A report of the surgeon general, US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Atlanta.
Van Zundert, R. M., Ferguson, S. G., Shiffman, S., & Engels, R. (2012). Dynamic effects of craving and negative affect on adolescent smoking relapse. Health Psychology, 31(2), 226–234. https://doi.org/10.1037/a0025204.
Vangeli, E., Stapleton, J., Smit, E. S., Borland, R., & West, R. (2011). Predictors of attempts to stop smoking and their success in adult general population samples: A systematic review. Addiction, 106(12), 2110–2121. https://doi.org/10.1111/j.1360-0443.2011.03565.x.
Varela-Mato, V., Cancela, J. M., Ayan, C., Martín, V., & Molina, A. (2012). Lifestyle and health among Spanish university students: Differences by gender and academic discipline. International Journal of Environmental Research and Public Health, 9(8), 2728–2741. https://doi.org/10.3390/ijerph9082728.
Walker, J. F., & Loprinzi, P. D. (2014). Longitudinal examination of predictors of smoking cessation in a national sample of U.S. adolescent and young adult smokers. Nicotine & Tobacco Research, 16(6), 820–827. https://doi.org/10.1093/ntr/ntu005.
West, R. (2005). Time for a change: Putting the transtheoretical (stages of change) model to rest. Addiction, 100(8), 1036–1039 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/?term=Time+for+a+change%3A+putting+the+Transtheoretical+(Stages+of+Change)+Model+to+rest.
West, R., Hajek, P., Stead, L., & Stapleton, J. (2005). Outcome criteria in smoking cessation trials: Proposal for a common standard. Addiction, 100, 299–303 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/?term=Outcome+criteria+in+smoking+cessation+trials%3A+proposal+for+a++common+standard.
Acknowledgments
The authors would like to extend their gratitude to the Chair of María Egea for the funding of this project, to the University of Navarra for allowing this study and to the participants, without whom this research would have not been possible. In addition, we would like to thank Dr. Cristina García-Vivar, Laura Iriarte and Sara Pueyo-Garrigues for their help during this study.
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This study was funded by the Chair of María Egea, University of Navarra (Spain).
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Pardavila-Belio, M.I., Ruiz-Canela, M. & Canga-Armayor, N. Predictors of Smoking Cessation Among College Students in a Pragmatic Randomized Controlled Trial. Prev Sci 20, 765–775 (2019). https://doi.org/10.1007/s11121-019-01004-6
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DOI: https://doi.org/10.1007/s11121-019-01004-6