AUG/SEPT 2004
Volume 10 - No. 3
SRNT Newsletter
August/September 2004, Volume 10, Number 3
Research Activities at a Highlighted Program:
The University of Wisconsin Transdisciplinary Tobacco Use Research Center (UW-TTURC)
As noted in the 2004 Surgeon General's Report, researchers have made great strides in discovering the health consequences of tobacco use and in developing tobacco cessation treatments. Despite these successes, very few tobacco users are able to maintain abstinence after a quit attempt, with estimates of relapse to smoking ranging from 93 to 98 percent. Thus, relapse remains the central, unanswered challenge to tobacco researchers today. The University of Wisconsin Transdisciplinary Tobacco Use Research Center (UW-TTURC) is focusing on this challenge by conducting research to understand tobacco dependence and withdrawal with the goal of preventing relapse and improving abstinence rates.
Research Activities: The UW-TTURC initiated three large research projects to achieve this goal. One, developing and evaluating a new measure of tobacco dependence, is designed to tap the motivational bases of tobacco addiction. A second project used hand-held computers to track withdrawal symptoms, stressor occurrence, high-risk events and coping responses to gain a better picture of a quit attempt and its mediation through medication and counseling. The third study used a specially-designed computer program to aid smokers in quitting and asked the questions, "Will randomly selected participants use a computer program? If so, will it help them quit?" All three studies had treatment components and several include genetic analysis done in collaboration with the University of Utah.
Preliminary Results: A common theme emerging from preliminary analysis of UW-TTURC research data is a greater variety in motives for smoking and in withdrawal symptoms than previously thought. The Wisconsin Inventory of Smoking Dependence Motives (WISDM-68), a research tool for assessing tobacco dependence, developed as part of the UW-TTURC, has uncovered surprising variability in smoking dependence motives. The WISDM-68 provides a more complete picture of smokers than previous measures by assessing 13 theoretically-based areas, including emotional attachment to smoking, response to other smokers, smoking to relieve stress, smoking for mental stimulation, a smoking environment, the sensation of smoking and smoking automatically.
Of special interest in this study were two groups - novice and experienced smokers. Novice smokers seemed to be more influenced by environment and the sensory aspects of smoking.
Their primary motivations to smoke included: being in a smoking environment, cues that encourage someone to smoke, and the taste and sensation of smoking. The experienced smokers were more influenced by cravings, automatic smoking, use of smoking to enhance mental activity, and emotional attachment to smoking. (Piper et al., 2004).
Preliminary results from data obtained from hand-held computers show variability in the severity of withdrawal and its pattern over time. This variability is related to a smoker's relapse risk. For example, individuals who experience greater increases in craving on the quit date are more vulnerable to relapse. The data suggest that analyzing withdrawal symptoms separately may reveal important differences in the susceptibility of symptoms to treatment. Urge reduction may be a mechanism through which combined bupropion and counseling increase abstinence rates. These results were presented at the 2004 American Psychological Association Annual Meeting. Researchers continue to explore variability in withdrawal symptoms to determine who is likely to have problematic withdrawal profiles and how treatment affects these profiles.
Early results in the computer study were presented at the 2004 SRNT Annual Meeting in two posters. The first poster examined participant ratings of the ease of obtaining various types of treatment aids and assistance. Results indicated that smokers who used the computer program, most often were more likely to report a high level of ease in obtaining information on quitting smoking and getting help with withdrawal or negative emotions, compared to those with low use and those receiving only a brief intervention. The second poster evaluated the smoking cessation success rates of program users and concluded that access to the computer program did not produce increased abstinence across all subjects. However, those who used the program heavily achieved greater success than those who used it less or not at all.
Future Directions: The variability of smoking motivation and withdrawal symptoms points toward research into individualization of treatmentÑresearch into the ways various treatments work and the long-term outcomes of smoking cessation. Knowing how medications work and gaining more specific information on their efficacy with individual smokers can provide better guidance to healthcare providers and policy makers. UW-TTURC policy research, supported by the Robert Wood Johnson Foundation, is already investigating insurance coverage of cessation medications. It is hoped that future research efforts may contribute to these kinds of policy decisions. In addition, tracing the history of smokers through a number of years can pinpoint the learning that occurs from numerous quit attempts and the types of treatments that work better with specific types of smokers. This research, combined with work being conducted on the genetics and physiology of tobacco addiction by TTURC researchers and others, may soon enable us to achieve much higher abstinence rates.
The UW-TTURC is one of seven centers across the country funded by the National Cancer Institute and the National Institute for Drug Abuse. Additional funding is provided by the Robert Wood Johnson Foundation. The UW-TTURC is housed at the Center for Tobacco Research and Intervention, University of Wisconsin Medical School.
Recent publications by the UW-TTURC:
Fiore, MC, McCarthy, DE, Jackson, TC, Zehner, ME, Jorenby, DE, Mielke, M, Smith, SS, Guiliani, TA, Baker, TB. (2004). Integrating smoking cessation treatment into primary care: an effectiveness study. Preventive Medicine, 38, 412-420.
Piper ME, Piasecki TM, Federman EB, Bolt DM, Smith SS, Fiore MC, & Baker TB. (2004). A multiple motives approach to tobacco dependence: the Wisconsin Inventory of Smoking Dependence Motives (WISDM-68). Journal of Consulting and Clinical Psychology, 72, 139-154.
Timothy Bajerm Co-Principal Investigator for the UW-TTURC (second from the left), discusses research findings with graduate students (left to right) Matt Majeskie, Danielle McCarthy, and Sandra Japuntich.
Sims, TH, Meurer, JR, Sims, M, & Layde, P.M. (2004). Factors associated with physician
interventions to address adolescent smoking. Health Services Research, 39, 571-585.