The association between changes in alternative reinforcers and short-term smoking cessation

Abstract

Background: While more than 50% of smokers make a serious quit attempt each year, less than 10% quit permanently. Evidence from studies of adolescent smoking and other substances of abuse suggest that alternative reinforcers, a construct of Behavioral Economic Theory, may contribute to the likelihood of smoking cessation in adults. This study examined the behavioral economics of smoking cessation within a smoking cessation clinical trial and evaluated how depressive symptoms and behavioral economic variables are associated with smoking cessation.

Methods: A sample of 469 smokers, enrolled in an effectiveness trial that provided counseling and 8 weeks of 21 mg nicotine patches, was analyzed. Alternative reinforcers (substitute and complementary reinforcers) and depressive symptoms were examined in relation to 7-day point prevalence abstinence, verified with breath carbon monoxide, 8 weeks after the quit date.

Results: Controlling for covariates associated with cessation (nicotine dependence, age of smoking initiation, patch adherence), participants who were abstinent at week 8 showed significantly higher substitute reinforcers at all time-points, compared to those who were smoking (p's<.05). Participants who were abstinent at week 8 showed lower complementary reinforcers and depressive symptoms at all time-points, compared to those who were smoking, but significant differences were confined to week 8 (p's<.01). There was no significant interaction between alternative reinforcers and depressive symptoms across the 8 weeks on week 8 abstinence.

Conclusions: These results support continued examination of Behavioral Economic Theory in understanding adult smoking cessation in order to inform future treatments and guidelines.

Keywords: Alternative reinforcers; Behavioral economics; Depression; Smoking cessation.

Figure 1

Participant Flow Note. *A list of the reasons for participant ineligibility can be provided by the authors upon request.

Figure 2

Change in Substitute and Complementary Reinforcers among Week 8 Smokers and Abstainers Note. FTND score, age of smoking initiation, and patch adherence were controlled for in GEE analyses; FTND score was significantly associated with week 8 abstinence in both models; patch adherence was significantly associated with week 8 abstinence in the substitute reinforcers model. Substitute reinforcer score ranges: Baseline (0-112); Week 0 (0-120); Week 4 (0-126); Week 8 (0-132). Complementary reinforcer score ranges: Baseline (0-154); Week 0 (0-103); Week 4 (0-90); Week 8 (0-78).

Figure 3

Change in Depressive Symptoms among Week 8 Smokers and Abstainers Note. FTND score, age of smoking initiation, and patch adherence were controlled for in GEE analysis; FTND score was significantly associated with week 8 abstinence in this model. Depressive symptoms score ranges: Baseline (0-48); Week 0 (0-55); Week 4 (0-48); Week 8 (0- 49).