title: Smoker characteristics and smoking-cessation milestones.
abstract: BACKGROUND
  Contextual variables often predict long-term abstinence, but little is known about how these variables exert their effects. These variables could influence abstinence by affecting the ability to quit at all, or by altering risk of lapsing, or progressing from a lapse to relapse.
  
  
  OBJECTIVE
  To examine the effect of common predictors of smoking-cessation failure on smoking-cessation processes.
  
  
  METHODS
  The current study (N=1504, 58% female, 84% Caucasian; recruited from January 2005 to June 2007; data analyzed in 2009) uses the approach advocated by Shiffman et al. (2006), which measures cessation outcomes on three different cessation milestones (achieving initial abstinence, lapse risk, and the lapse-relapse transition) to examine relationships of smoker characteristics (dependence, contextual and demographic factors) with smoking-cessation process.
  
  
  RESULTS
  High nicotine dependence strongly predicted all milestones: not achieving initial abstinence, and a higher risk of both lapse and transitioning from lapse to complete relapse. Numerous contextual and demographic variables were associated with higher initial cessation rates and/or decreased lapse risk at 6 months post-quit (e.g., ethnicity, gender, marital status, education, smoking in the workplace, number of smokers in the social network, and number of supportive others). However, aside from nicotine dependence, only gender significantly predicted the risk of transition from lapse to relapse.
  
  
  CONCLUSIONS
  These findings demonstrate that (1) higher nicotine dependence predicted worse outcomes across every cessation milestone; (2) demographic and contextual variables are generally associated with initial abstinence rates and lapse risk and not the lapse-relapse transition. These results identify groups who are at risk for failure at specific stages of the smoking-cessation process, and this may have implications for treatment.
authors.affiliation: Mongan Institute for Health Policy and Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, 50 Staniford Street, Boston, MA 02114, USA. sjapuntich@partners.org
authors.forename: Sandra J
authors.initials: SJ
authors.lastname: Japuntich
authors.forename: Adam M
authors.initials: AM
authors.lastname: Leventhal
authors.forename: Megan E
authors.initials: ME
authors.lastname: Piper
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Bolt
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Roberts
authors.forename: Michael C
authors.initials: MC
authors.lastname: Fiore
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Baker
mesh_terms: D000328:Adult; D016642:Bupropion / Q000008:administration & dosage / Q000627:therapeutic use; D018765:Dopamine Uptake Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000008:administration & dosage / Q000627:therapeutic use; D018722:Nicotinic Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D012008:Recurrence; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology*; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D012944:Social Support; D014029:Tobacco Use Disorder / Q000534:rehabilitation*; D017211:Treatment Failure
chemical_list: D018765:Dopamine Uptake Inhibitors; D018722:Nicotinic Agonists; D016642:Bupropion; D009538:Nicotine