To evaluate the effectiveness of a cognitive behavioral treatment (CBT) addressing cessation-related weight concerns delivered via a tobacco quitline that does not address weight concerns.
All 7998 smokers who called the OKHL were screened; 4240 were eligible; 2000 were randomized to the standard quitline (STD) or the brief version of the CBT weight concerns program (WCP).
Intervention.
Telephone counseling to help people quit smoking and address concerns about cessation-related weight gain.
Measures.
Demographics, weight, tobacco status, weight concerns, self-efficacy in quitting, and quitting without weight gain.
Analysis.
Descriptive statistics and logistic regression.
Results.
Of those randomized, 1002 participants completed the 6-month survey (response rates = 53.2% for STD, 47% for WCP). Compared with STD, WCP led to reduced weight concerns (p < .01) and less weight gain among quitters (1.8 vs. −3.4 pounds; p = .01). Although not significant, participants in the WCP were more likely to report 30-day abstinence (33.3% vs. 36.8%, p = .24; intent to treat = 17.7 vs. 17.3).
Conclusion.
The WCP was successfully delivered via a quitline and resulted in improved attitudes about weight and decreased cessation-related weight gain without harming quit rates. Promotion of a quitline focused on addressing weight in conjunction with quitline treatment for smoking cessation may improve cessation and weight outcomes. Study limitations include use of self-report and survey response.
FinkelsteinEAFiebelkornICWangG. National medical spending attributable to overweight and obesity: How much, and who's paying?Health Aff (Millwood). 2003;Suppl Web Exclusives:W3–219–W3–226.
2.
FreedmanDMSigurdsonAJRajaramanP. The mortality risk of smoking and obesity combined. Am J Prev Med.2006;31:355–362.
3.
DallTMZhangYChenYJ. Cost associated with being overweight and with obesity, high alcohol consumption, and tobacco use within the military health system's TRICARE prime-enrolled population. Am J Health Promot. 2007;22:120–139.
4.
ZhuSAndersonCMTedeschiGJ. Evidence of real-world effectiveness of a telephone quitline for smokers. N Engl J Med.2002;347:1087–1093.
5.
FioreMCJaenCRBakerTB. Treating Tobacco Use and Dependence: 2008 Update. Clinical practice guideline. Rockville, MD: US Dept of Health and Human Services, Public Health Service; 2008.
6.
WilliamsonDFMadansJAndaRF. Smoking cessation and severity of weight gain in a national cohort. N Engl J Med.1991;324:739–745.
7.
LycettDMunafòMJohnstoneE. Associations between weight change over 8 years and baseline body mass index in a cohort of continuing and quitting smokers. Addiction. 2010;106:188–196.
8.
EisenbergDQuinnBC. Estimating the effect of smoking cessation on weight gain: An instrumental variable approach. Health Serv Res.2006;41:2255–2267.
9.
SwanGEJavitzHSJackLM. Heterogeneity in 12-month outcome among female and male smokers. Addiction. 2004;99:237–250.
10.
YehHCDuncanBBSchmidtMI. Smoking, smoking cessation, and risk for type 2 diabetes mellitus. Ann Intern Med.2010;152:10–17.
11.
GeraceTAHollisJOckeneJKSvendsenK. Smoking cessation and change in diastolic blood pressure, body weight, and plasma lipids. Prev Med.1991;20:602–620.
12.
AlbergAJCarterCLCarpenterMJ. Weight gain as an impediment to cigarette smoking cessation: A lingering problem in need of solutions. Prev Med.2007;44:296–297.
13.
KlesgesRCBrownKPascaleRW. Factors associated with participation, attrition, and outcome in a smoking cessation program at the workplace. Health Psychol. 1988;7:575–589.
14.
WhiteMAMcKeeSAO'MalleySS. Smoke and mirrors: Magnified beliefs that cigarette smoking suppresses weight. Addict Behav.2007;31:1144–1152.
15.
BorrelliBMermelsteinR. The role of weight concern and self-efficacy in smoking cessation and weight gain among smokers in a clinic-based cessation program. Addict Behav.1998;23:609–622.
16.
CopelandALMartinPDGeiselmanPJ. Smoking cessation for weight-concerned women: Group vs. individually tailored, dietary, and weight-control follow-up sessions. Addict Behav.2006;31:115–127.
17.
JefferyRWHennrikusDJLandoHA. Reconciling conflicting findings regarding postcessation weight concerns and success in smoking cessation. Health Psychol. 2000;19:242–246.
18.
ClarkMMHurtRDCroghanIT. The prevalence of weight concerns in a smoking abstinence clinical trial. Addict Behav.2006;31:1144–1152.
19.
BushTMLevineMDDepreyTM. Prevalence of weight concerns and obesity among smokers calling a quitline. J Smok Cessat. 2009;4:74–78.
20.
SpringBHoweDBerendsenM. Behavioral intervention to promote smoking cessation and prevent weight gain: A systematic review and meta-analysis. Addiction. 2009;104:1472–1486.
21.
PerkinsKAMarcusMLevineM. Cognitive-behavioral therapy to reduce weight concerns improves smoking cessation outcome in weight-concerned women. J Consult Clin Psychol. 2001;69:604–613.
22.
LevineMDPerkinsKAKalarchianMA. Bupropion and cognitive behavioral therapy for weight-concerned women smokers. Arch Intern Med.2010;170:543–550.
23.
StunkardAJWaddenTA. Obesity: Theory. 2nd ed.New York, NY: Raven Press; 1993.
24.
CurrySJGrothausLCMcAfeeTPabiniakC. Use and cost effectiveness of smoking-cessation services under four insurance plans in a health maintenance organization. N Engl J Med.1998;339:673–679.
25.
El-BastawissiAMcAfeeTZbikowskiSM. The uninsured and Medicaid Oregon tobacco user experience in a real world, phone based cessation programme. Tob Control. 2003;12:45–51.
26.
HollisJFMcAfeeTAFellowsJL. The effectiveness and cost effectiveness of telephone counselling and the nicotine patch in a state tobacco quitline. Tob Control. 2007;16(suppl 1):i53–i59.
27.
McAfeeTABushTDepreyM. Nicotine patches and uninsured quitline callers: A randomized trial of two versus eight weeks. Am J Prev Med.2008;35:103–110.
28.
OrleansCTSchoenbachVJWagnerEH. Self-help quit smoking interventions: Effects of self-help materials, social support instructions, and telephone counseling. J Consult Clin Psychol. 1991;59:439–448.
29.
RingenKAndersonNMcAfeeT. Smoking cessation in a blue-collar population: Results from an evidence-based pilot program. Am J Ind Med.2002;42:367–377.
30.
SwanGEJackLMCurrySJ. Bupropion SR and counseling for smoking cessation in actual practice: Predictors of outcome. Nicotine Tob Res.2003;5:911–921.
31.
BanduraA. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice-Hall; 1986.
32.
PerkinsKALevineMDMarcusMDShiffmanS. Addressing women's concerns about weight gain due to smoking cessation. J Subst Abuse Treat.1997;14:173–182.
33.
LevineMDMarcusMDPerkinsKA. A cognitive behavioral approach to women's concerns about weight gain following smoking cessation. Cogn Behav Pract.2003;10:105–111.
34.
Carlin-MenterSCummingsKMCelestinoP. Does offering more support calls to smokers influence quit success?J Public Health Manag Pract.2011;17:E9–E15.
35.
ParsonsAShraimMInglisJ. Interventions for preventing weight gain after smoking cessation. Cochrane Database Syst Rev.2009(1):CD006219.
36.
HokansonJMAndersonRLHennrikusDJ. Integrated tobacco cessation counseling in a diabetes self-management training program: A randomized clinical trial of diabetes and reduction of tobacco. Diabetes Educ.2006;32:562–570.
