Decision-Tree Model of Long-term Abstention from Smoking: Focused on Coping Styles

장기적 금연 지속기간 예측 모형: 스트레스 대처를 중심으로

  • Suh, Kyung-Hyun (Graduate School of Public Health and Social Welfare, Sahmyook University) ;
  • You, Jae-Min (College of Liberal Arts, Kangnam University)
  • Published : 2005.12.30

Abstract

Objectives: Smokers who had failed to quit smoking were frequently reported that life stress mostly interrupted their abstention. Stress vulnerability model for smoking cessation has been considered, and most of contemporary smoking cessation programs help smokers develop coping strategies for stressful situations. This study aims to investigate the appropriate coping styles for stress of abstention from smoking. The result of investigating the relationship between abstention following smoking cessation program and coping styles would suggest useful information for those who want to stop smoking and health practitioners who help them. Methods: Participants were 69 smokers (62 males, 7 females) participated in a hospitalized smoking cessation program, whose mean age was 44.89 (SD=9.61). Participants took medical test and completed questionnaires and psychological tests including: Fagerstrom Test for Nicotine Dependence and Multidimensional Coping Scale. To identify participants' abstention, researchers followed them for 2 years. To identify whether abstained or not and encourage them to abstain, researchers called them on the telephone once a week for 3 months. After 3 months, they were contacted every other week till 6 months passed since they left smoking cessation program. And they were contacted once a month for other 18months. Researchers also contacted their family to identify their abstention. Data Mining Decision Tree was performed with 37 variables (13 variables for the coping styles and 24 smoking-related variables) by Answer Tree 3.0v Results: Forty four (63.8%) out of sixty nine for 2 weeks, 34 (49.3%) for 6 months, 25 (36.2%) abstained for 1 year, and 22 (31.9%) abstained for 2 years. Participants of this study abstained average of 286.77 days from smoking. Included variables of a Decision Tree model for this study were positive interpretation, emotional expression, self-criticism, restraint and emotional social support seeking. Decision Tree model showed that those (n=9) who did not interpret positively (<=7.5) and criticized themselves (>6.5) abstained 23 days only, while those (n=9) who interpreted positively (>7.5), expressed their emotion freely (>6.5), and sought social support actively (>11.5) abstained 730 days, till last day of the investigation. Conclusion: The results of this study showed that certain coping styles such as positive interpretation, emotional expression, self-criticism, restraint and emotional social support seeking were important factors for long-term abstention from smoking. These findings reiterate the role of stress for abstention from smoking and suggest a model of coping styles for successful abstention from smoking. Despite of limitation of this study, it might help smokers who want to stop smoking and health practitioners who help them.

Keywords

References

  1. 김한중. 흡연의 사회 경제적 비용. 한국금연운동협의회 편, 흡연과 건강. 서울: 한국금연운동협의회,2000. 쪽 109-118
  2. 보건복지부. 국민건강증진종합계획(Health Plan 2010). 경기: 보건복지부,2002
  3. 서경현, 이경순. 금연프로그램 참여 후의 금연 경험. 한국심리학회지:건강 2002;7:63-79
  4. 송선희,하은혜,송동호. 성인 남성의 흡연과 관련된 심리사회적 변인: 종합병원 건강증진센터 내원자를 대상으로. 한국심리학회지: 건강 2002;7:447-467
  5. 전겸구,김교헌, 조신웅, 노병래 손정락. 다차원적 대처 척도의 개발발. 한국심리학회지: 임상 1994;13:114-135
  6. 지선하. 흡연에 의한 질병 부담. 한국금연운동협의회 편, 흡연과 건강. 서울: 한국금연운동협의회, 2000. 쪽 57-63
  7. 한국금연운동협의회. 흡연과 건강. 서울: 한국금연 운동협의회,2000
  8. 한국금연운동협의회. 성인 흡연율 조사. 서울: 한국 금연운동협의회,2002
  9. 한국금연운동협의회. 성인 흡연율 조사. 서울: 한국 금연운동협의회,2003
  10. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Washington D.C., 1994
  11. Borland R, Owen N, Hill D, Schofield P. Predicting attempts and sustained cessation of smoking after the introduction of workplace smoking bans, Health Psychology 1991;10: 336-342 https://doi.org/10.1037/0278-6133.10.5.336
  12. Brannon L, Feist J. Health psychology: An introduction to behavior and health. Belmont: Wordsworth, 2000
  13. Covey LS, Glassman AH, Stetner F. Depression and depressive symptoms in smoking cessation. Comparative Psychiatry 1999;31: 350-354 https://doi.org/10.1016/0010-440X(90)90042-Q
  14. Dattore PJ, Shontz Fe, Coyne L. Premorbid personality differentiation of cancer and non-cancer groups: A list of the hypotheses of cancer proneness. Journal of Consulting and Clinical Psychology 1980;48:388-394 https://doi.org/10.1037/0022-006X.48.3.388
  15. Doll R, Peto R, Wheatley K, Gray R, Sutherland I. Mortality in relation to smoking: 40 years' observation on male British doctors. British Medical Journal 1994;309: 901-911 https://doi.org/10.1136/bmj.309.6959.901
  16. Gourlay S, Forbes A, Marriner T, Pethica D, McNeil J. Prospective study of factors predicting outcome of transdermal nicotine treatment in smoking cessation. British Medical Journal 1994;309:842-846 https://doi.org/10.1136/bmj.309.6958.842
  17. Fagerstrom KO. Towards better diagnoses and more individual treatment of tobacco dependence. British Journal of Medicine 1991;12:159-182 https://doi.org/10.1136/bmj.s1-12.6.159
  18. Farkas A et al. Addiction versus stages of change models in predicting smoking cessation. Addiction 1996;91:1281-1292 https://doi.org/10.1111/j.1360-0443.1996.tb03609.x
  19. Hebert J et al. Patient characteristics and the effect of three physician-delivered smoking interventions. Preventive Medicine 1992;21: 557-573 https://doi.org/10.1016/0091-7435(92)90064-O
  20. Hetziandreu EJ et al. Quitting smoking in the United States in 1986. Journal of the National Cancer Institute 1990;82:1402-1406 https://doi.org/10.1093/jnci/82.17.1402
  21. Hibbard H. Social roles as predictors of cessation in a cohort of women smokers. Women and Health 1993;20:71-79 https://doi.org/10.1300/J013v20n02_08
  22. Hughes JR. Smoking cessation among self-quitters. Health Psychology 1992;1: 331-334
  23. Hymowitz N, Cummings K, Hyland A, Pechacelk T, Hartwell T. Predictors of smoking cessation in a cohort of adult smokers followed for five years. Tobacco Control 1997;6:57-62 https://doi.org/10.1136/tc.6.suppl_2.S57
  24. Jacobsen B. The Ladykillers: why smoking is a feminist issue. London: Pluto Press, 1981
  25. Kabat GC, Wynder EL. Determinants of quitting smoking. American Journal of Public Health 1987;77: 1301-1305 https://doi.org/10.2105/AJPH.77.10.1301
  26. Kaprio J, Koskenvuo M. A prospective study of psychological and socioeconomic characteristics, health behavior and morbidity in cigarette smokers prior to quitting compared to persistent smokers and non-smoker. Journal cf Clinical Epidemiology 1988;41: 139-150 https://doi.org/10.1016/0895-4356(88)90088-1
  27. Krall EA. Smoking relapse rates drop sharply after two years. Alcoholism & Drug Abuse Weekly 2002;14:6
  28. Mothersill KJ, McDowell I, Rosser W. Subject characteristics and long-term post programme smoking cessation. Addictive Behavior 1988;13:29-36 https://doi.org/10.1016/0306-4603(88)90022-6
  29. Ockene JK et al. Factors related to patient smoking status, American Journal of Public Health 1987;77:356-357 https://doi.org/10.2105/AJPH.77.3.356
  30. Peto R. Smoking and death: The past 40 years and next 40 years. Behavior Medicine Journal 1994;319: 937-939
  31. Pomerleau OF, Adkins D, Pertschuk M. Predictors of outcome and recidivism in smoking cessation treatment. Addictive Behaviors 1978;3:65-70 https://doi.org/10.1016/0306-4603(78)90028-X
  32. Pomerleau CS, Pomerleau OF. The effects of a psychological stressor on cigarette smoking and on subsequent behavioral and physiological responses. Psychophysiology 1987;24:278-285 https://doi.org/10.1111/j.1469-8986.1987.tb00295.x
  33. Richmond R, Austin A, Webster I. Predicting abstainers in a smoking cessation programme administered by general practitioners. International Journal of Epidemiology 1988;17:530-534 https://doi.org/10.1093/ije/17.3.530
  34. Richmond R, Kehoe L, Webster I. Multivariate models for predicting abstention following intervention to stop smoking by general practitioners. Addiction 1993;88:1127-1135 https://doi.org/10.1111/j.1360-0443.1993.tb02132.x
  35. Rohren C. Predicting smoking cessation outcome in a medical center from readiness: contemplation versus action. Preventive Medicine 1994;23:335-344 https://doi.org/10.1006/pmed.1994.1047
  36. Senore C et al. Predictors of smoking cessation following physicians' counselling. Preventive Medicine 1998;27:412-421 https://doi.org/10.1006/pmed.1998.0286
  37. Shadel WG, Mermelstein RJ, Cigarette smoking under stress: the role of coping expectancies among smokers in a clinic-based smoking cessation program. Health Psychology 1993;12:443-450 https://doi.org/10.1037/0278-6133.12.6.443
  38. Shaffer JW, Graves PL, Swank RT, Pearson TA. Clustering of personality traits in youth and the subsequent development of cancer among physicians. Journal of Behavioral Medicine 1987;10:441-447 https://doi.org/10.1007/BF00846143
  39. Solomon GF. Psychoneuroimmunology; Interactions between central nervous system and immune system. Journal of Nueroscience Research 1987;18:1-9 https://doi.org/10.1002/jnr.490180103
  40. Spiegel D, Kato P. Psychosocial influences on cancer incidence and progression. Archives of General Psychiatry 1996;4:10-26
  41. Sussman S, Dent CW, Burton D, Stacy A, Flay BR. Developing school-based tobacco use prevention and cessation program Sage, 1995
  42. Swan GE, Ward MM, Jack LM, Javitz HS. Cardiovascular reactivity as a predictor of relapse in male and female smokers. Health Psychology 1993;12:451-458 https://doi.org/10.1037/0278-6133.12.6.451
  43. Tiffany SR, Drobes DJ. Imagery and smoking urges: the manipulation of affective content. Addictive Behaviors 1990;15:531-539 https://doi.org/10.1016/0306-4603(90)90053-Z
  44. Wasburton DM. Smoking within reason. Journal of Smoking-Related Disorders 1992;3:55-59
  45. West R, McEwen A, Bates C. Sex and Smoking: comparisons between male and female smokers. No Smoking Day, 1999
  46. Wetter DW et al. Smoking cessation clinical practice guideline: Finding and implications for psychologist. American Psychologist 1993;53:657-669 https://doi.org/10.1037/0003-066X.53.6.657
  47. Wilcox N, Prochaska J, Velicer W, Diclemente C. Subject characteristics as predictors of self-change in smoking. Addictive Behaviors 1985;10:407-412 https://doi.org/10.1016/0306-4603(85)90037-1
  48. World Health Organization. Building Blocks for Tobacco Control. Geneva: WHO Press. 2004