Skip to main content

Advertisement

SpringerLink
Log in

Smoking cessation patterns, usefulness of quitting methods, and tobacco cessation motivators and barriers to quit in patients with rheumatoid arthritis

  • ORIGINAL ARTICLE
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Objective

Tobacco use is highly discouraged in patients with rheumatoid arthritis (RA) due to related short and long-term health implications. We aimed to evaluate smoking cessation patterns in patients with RA. In addition, we ascertained perceptions on the usefulness of quitting methods, and perceived motivators and barriers to quit.

Methods

We surveyed adults with RA enrolled in the FORWARD Databank who self-identified as former or current tobacco users.

Results

Three hundred forty-eight participants completed the survey and responded to the question “do you currently smoke” (former use = 319; current use = 29). Nicotine replacement therapy (NRT) was perceived as extremely/somewhat useful by 31%, followed by individual 27% and group counseling 21%. Experiencing a major health event was the most common motivator to quit. Current users on average smoked 17 cigarettes per day. Six of the 29 current users had used electronic cigarettes in the past 30 days. The most frequent methods used to quit were “cold turkey quitting,” NRT, and prescription medicines. Only 8 of the 23 current users had plans to quit or expressed being ready to make changes to quit. Reasons most frequently listed to not quit were using smoking to manage negative emotions, as a pleasurable habit, to manage other addictions, and to provide a sense of control (e.g., to cope with RA).

Conclusions

Current users expressed several negative emotions including coping with the disease and “being a pleasurable habit” when trying to quit. Future cessation programs should address these barriers to support patients with RA.

Key Points

• First study characterizing the smoking behavior of patients with RA in the USA. Current users were younger, had a shorter disease duration, and worse disease outcomes compared to former smokers.

• Former and current users reported similar motivators to quit, with experiencing a major health event being most common. Only about a third of participants who quit or who were still smoking received advice from a health professional.

• The most common reasons for not quitting were that smoking help to manage negative emotions and was a pleasurable habit. Future studies should focus on cessation programs that support participants with RA by addressing the unique perceptions about smoking in this population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability

The data that support the findings of this study are available from the corresponding author, [M.E.S.-A.], upon reasonable request.

References

  1. Naranjo A, Sokka T, Descalzo MA, Calvo-Alén J, Hørslev-Petersen K, Luukkainen RK et al (2008) Cardiovascular disease in patients with rheumatoid arthritis: results from the QUEST-RA study. Arthritis Res Ther 10(2):R30

    Article  PubMed  PubMed Central  Google Scholar 

  2. Hutchinson D, Shepstone L, Moots R, Lear JT, Lynch MP (2001) Heavy cigarette smoking is strongly associated with rheumatoid arthritis (RA), particularly in patients without a family history of RA. Ann Rheum Dis 60(3):223–227

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Joseph RM, Movahedi M, Dixon WG, Symmons DP (2017) Risks of smoking and benefits of smoking cessation on hospitalisations for cardiovascular events and respiratory infection in patients with rheumatoid arthritis: a retrospective cohort study using the Clinical Practice Research Datalink. RMD Open 3(2):e000506

    Article  PubMed  PubMed Central  Google Scholar 

  4. Edgerton C, Radtchenko J, Holers VM (2020) Outpatient costs in rheumatoid arthritis (RA) patients with vs without comorbidities. Value Health 23:S214

  5. Godtfredsen NS, Lam TH, Hansel TT, Leon ME, Gray N, Dresler C et al (2008) COPD-related morbidity and mortality after smoking cessation: status of the evidence. Eur Respir J 32(4):844–853

    Article  CAS  PubMed  Google Scholar 

  6. Sparks JA, Chang SC, Nguyen UDT, Barbhaiya M, Tedeschi SK, Lu B et al (2018) Smoking behavior changes in the early rheumatoid arthritis period and risk of mortality during thirty-six years of prospective follow-up. Arthritis Care Res (Hoboken) 70(1):19–29

    Article  PubMed  Google Scholar 

  7. Cornuz J, Feskanich D, Willett WC, Colditz GA (1999) Smoking, smoking cessation, and risk of hip fracture in women. Am J Med 106(3):311–314

    Article  CAS  PubMed  Google Scholar 

  8. Peto R, Darby S, Deo H, Silcocks P, Whitley E, Doll R (2000) Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies. Brit Med J 321(7257):323–329

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Andersson ML, Bergman S, Soderlin MK (2012) The effect of stopping smoking on disease activity in rheumatoid arthritis (RA). Data from BARFOT, a multicenter study of early RA. Open Rheumatol J. 6:303–9

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hartmann-Boyce J, Chepkin SC, Ye W, Bullen C, Lancaster T (2018) Nicotine replacement therapy versus control for smoking cessation. Cochrane Database Syst Rev. 5:CD000146

    PubMed  Google Scholar 

  11. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP et al (2007) Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 335(7624):806–808

    Article  Google Scholar 

  12. Wolfe F, Michaud K (2011) The National Data Bank for rheumatic diseases: a multi-registry rheumatic disease data bank. Rheumatology (Oxford) 50(1):16–24

    Article  PubMed  Google Scholar 

  13. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd et al (2010) 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 62(9):2569–2581

    Article  PubMed  Google Scholar 

  14. Aimer P, Stamp LK, Stebbings S, Cameron V, Kirby S, Treharne GJ (2018) Exploring perceptions of a rheumatoid arthritis-specific smoking cessation programme. Musculoskelet Care 16(1):74–81

    Article  Google Scholar 

  15. Gath ME, Stamp LK, Aimer P, Stebbings S, Treharne GJ (2018) Reconceptualizing motivation for smoking cessation among people with rheumatoid arthritis as incentives and facilitators. Musculoskelet Care 16(1):139–146

    Article  Google Scholar 

  16. Roelsgaard IK, Thomsen T, Ostergaard M, Semb AG, Andersen L, Esbensen BA (2020) How do people with rheumatoid arthritis experience participation in a smoking cessation trial: a qualitative study. Int J Qual Stud Heal 15(1):1725997

    Article  Google Scholar 

  17. Stamp LK, Gath M, Aimer P, Stebbings S, Treharne G. Promoting smoking cessation among rheumatoid arthritis patients: what motivations and barriers are reported after being offered a smoking cessation intervention? Arthritis Rheumatol. 2015;67: https://acrabstracts.org/abstract/promoting-smoking-cessation-among-rheumatoid-arthritis-patients-what-motivations-and-barriers-are-reported-after-being-offered-a-smoking-cessation-intervention/. Accessed November 7, 2022.

  18. Wattiaux A, Bettendorf B, Block L, Gilmore-Bykovskyi A, Ramly E, Piper ME et al (2020) Patient perspectives on smoking cessation and interventions in rheumatology clinics. Arthrit Care Res 72(3):369–377

    Article  Google Scholar 

  19. Biener L, Abrams DB (1991) The contemplation ladder: validation of a measure of readiness to consider smoking cessation. Health Psychol 10(5):360–365

    Article  CAS  PubMed  Google Scholar 

  20. Twyman L, Bonevski B, Paul C, Bryant J (2014) Perceived barriers to smoking cessation in selected vulnerable groups: a systematic review of the qualitative and quantitative literature. BMJ Open 4(12):e006414

    Article  PubMed  PubMed Central  Google Scholar 

  21. Fries JF, Spitz PW, Young DY (1982) The dimensions of health outcomes: the health assessment questionnaire, disability and pain scales. J Rheumatol 9(5):789–793

    CAS  PubMed  Google Scholar 

  22. Kim J, Neilipovitz D, Cardinal P, Chiu M (2009) A comparison of global rating scale and checklist scores in the validation of an evaluation tool to assess performance in the resuscitation of critically ill patients during simulated emergencies (abbreviated as “CRM simulator study IB”). Simul Healthc 4(1):6–16

    Article  PubMed  Google Scholar 

  23. Michaud K, Wolfe F (2007) Comorbidities in rheumatoid arthritis. Best Pract Res Clin Rheumatol 21(5):885–906

    Article  PubMed  Google Scholar 

  24. England BR, Sayles H, Mikuls TR, Johnson DS, Michaud K (2015) Validation of the rheumatic disease comorbidity index. Arthritis Care Res (Hoboken) 67(6):865–872

    Article  PubMed  Google Scholar 

  25. Cornelius ME, Loretan CG, Wang TW, Jamal A, Homa DM (2022) Tobacco product use among adults - United States, 2020. Mmwr-Morbid Mortal W 71(11):397–405

    Article  Google Scholar 

  26. Kim Y, Cho WK (2014) Factors associated with successful smoking cessation in Korean adult males: findings from a national survey. Iran J Public Health 43(11):1486–1496

    PubMed  PubMed Central  Google Scholar 

  27. Monso E, Campbell J, Tonnesen P, Gustavsson G, Morera J (2001) Sociodemographic predictors of success in smoking intervention. Tob Control 10(2):165–169

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Lee CW, Kahende J (2007) Factors associated with successful smoking cessation in the United States, 2000. Am J Public Health 97(8):1503–1509

    Article  PubMed  PubMed Central  Google Scholar 

  29. Pineiro B, Lopez-Duran A, Del Rio EF, Martinez U, Brandon TH, Becona E (2016) Motivation to quit as a predictor of smoking cessation and abstinence maintenance among treated Spanish smokers. Addict Behav 53:40–45

    Article  PubMed  Google Scholar 

  30. Layoun N, Hallit S, Waked M, Aoun Bacha Z, Godin I, Dramaix M et al (2017) Predictors of readiness to quit stages and intention to quit cigarette smoking in 2 and 6 months in Lebanon. J Res Health Sci 17(2):e00379

    PubMed  Google Scholar 

  31. Caraballo RS, Shafer PR, Patel D, Davis KC, McAfee TA (2017) Quit methods used by US adult cigarette smokers, 2014–2016. Prev Chronic Dis 14:160600

    Article  Google Scholar 

  32. Lund M, Kvaavik E (2021) Methods used in smoking cessation and reduction attempts: findings from help-seeking smokers. J Smok Cessat 2021:6670628

    Article  PubMed  PubMed Central  Google Scholar 

  33. Lewis JA, Senft N, Chen H, Weaver KE, Spalluto LB, Sandler KL et al (2021) Evidence-based smoking cessation treatment: a comparison by healthcare system. BMC Health Serv Res 21(1):33

    Article  PubMed  PubMed Central  Google Scholar 

  34. Yano EM, Rubenstein LV, Farmer MM, Chernof BA, Mittman BS, Lanto AB et al (2008) Targeting primary care referrals to smoking cessation clinics does not improve quit rates: implementing evidence-based interventions into practice. Health Serv Res 43(5 Pt 1):1637–1661

    Article  PubMed  PubMed Central  Google Scholar 

  35. Lopez-Olivo MA, Minnix JA, Fox JG, Nishi SPE, Lowenstein LM, Maki KG et al (2021) Smoking cessation and shared decision-making practices about lung cancer screening among primary care providers. Cancer Med 10(4):1357–1365

    Article  PubMed  PubMed Central  Google Scholar 

  36. Chang K, Yang SM, Kim SH, Han KH, Park SJ, Shin JI (2014) Smoking and rheumatoid arthritis. Int J Mol Sci 15(12):22279–22295

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Di Giuseppe D, Discacciati A, Orsini N, Wolk A (2014) Cigarette smoking and risk of rheumatoid arthritis: a dose-response meta-analysis. Arthritis Res Ther 16(2):R61

    Article  PubMed  PubMed Central  Google Scholar 

  38. Sugiyama D, Nishimura K, Tamaki K, Tsuji G, Nakazawa T, Morinobu A et al (2010) Impact of smoking as a risk factor for developing rheumatoid arthritis: a meta-analysis of observational studies. Ann Rheum Dis 69(1):70–81

    Article  CAS  PubMed  Google Scholar 

  39. Sokolove J, Wagner CA, Lahey LJ, Sayles H, Duryee MJ, Reimold AM et al (2016) Increased inflammation and disease activity among current cigarette smokers with rheumatoid arthritis: a cross-sectional analysis of US veterans. Rheumatology (Oxford) 55(11):1969–1977

    Article  PubMed  Google Scholar 

  40. Esbensen BA, Roelsgaard IK, Larsen SK, Thomsen T (2020) Tobacco addiction in people with rheumatoid arthritis - from the perspective of patients. Ann Rheum Dis. 79:1948

    Article  Google Scholar 

  41. Schletzbaum M, Wang X, Greenlee R, Piper ME, Bartels CM (2021) Predictors of smoking cessation in patients with rheumatoid arthritis in two cohorts: most predictive health care factors. Arthritis Care Res (Hoboken) 73(5):633–639

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Editorial support was provided by Bryan Tutt, Scientific Editor, Research Medical Library.

Funding

This study was supported by the University of Texas MD Anderson Cancer Center Tobacco Settlement Funds Research Resource Program (Maria E. Suarez-Almazor, PhD, Principal Investigator).

Author information

Authors and Affiliations

  1. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1444, Houston, TX, 77030, USA

    Maria A. Lopez-Olivo & Maria E. Suarez-Almazor

  2. FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, USA

    Kaleb Michaud & Rebecca Schumacher

  3. Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA

    Kaleb Michaud

  4. Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jennifer Minnix & Paul Cinciripini

  5. Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Maria E. Suarez-Almazor

Authors
  1. Maria A. Lopez-Olivo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kaleb Michaud
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rebecca Schumacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jennifer Minnix
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Paul Cinciripini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maria E. Suarez-Almazor
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Lopez-Olivo MA and Schumacher R. The first draft of the manuscript was written by Lopez-Olivo MA and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Maria E. Suarez-Almazor.

Ethics declarations

Disclosures

None.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 98 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lopez-Olivo, M.A., Michaud, K., Schumacher, R. et al. Smoking cessation patterns, usefulness of quitting methods, and tobacco cessation motivators and barriers to quit in patients with rheumatoid arthritis. Clin Rheumatol 42, 2053–2068 (2023). https://doi.org/10.1007/s10067-023-06593-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-023-06593-w

Keywords

Search

Navigation