University Times

Roughly 47 million people in the United States smoke cigarettes. At any one time, more than 70 percent of those smokers report that they would like to quit smoking and about 17 million Americans annually attempt to quit.

"I think a lot of those efforts are probably fairly weak," says Saul Shiffman, director of the psychology department's smoking research group. "There is a huge amount of interest in quitting, but the success rate is really quite low." As the American Cancer Society encourages people to stop smoking through its "Great American Smoke Out" program today, Nov. 21, Shiffman says a person's success in giving up cigarettes largely depends upon the method he or she uses to quit. For most people who try to quit on their own, without behavioral counseling or medication in the form of nicotine patches and gum, the success rate is startlingly low, only 3-5 percent.

Patches and gum approximately double that rate, according to Shiffman, but the highest success comes when medication is combined with other treatment methods, such as counseling. Then the success rate climbs to 30-40 percent.

"But it's still under 50 percent," Shiffman points out, adding, "In some ways, what you get out of it depends upon what you put in." The most difficult obstacle smokers face when they try to quit is not stopping, according to Shiffman, but rather staying off cigarettes. About 80 percent of smokers who quit end up relapsing within six months.

"In a way, it's a puzzle," he says. "You have someone who has put a lot of effort, sometimes perhaps spent money, to quit smoking. They've worked at it. They say they're committed. They achieve it, and then within weeks they go back." In hopes of understanding why so many smokers who quit relapse, Shiffman and his colleagues, have been conducting some innovative studies using small, handheld computers.

One of the challenges in studying smoking recidivism, Shiffman explains, is that it occurs in people's real lives and is not something that can be brought into the laboratory.

To bridge the gap between real life and the laboratory, the smoking research group has been using palm-sized computers programmed to allow smokers to report on their experiences as they go through the quitting process.

Earlier researchers had subjects use index cards during studies, but Shiffman says the cards never worked very well because they were a hassle for most participants.

The cards also had a major defect that made them almost useless. Often people would forget to fill them out when they were experiencing cravings or after they had smoked a cigarette, and then would sit down and complete a stack of them at the end of a study, which resulted in false data. Among the things that the computers do are beep study participants at random to ask them questions about cravings and their mood. Participants also can initiate a recording if they smoke a cigarette or have a strong urge to smoke a cigarette.

The purpose of such computer studies is to help researchers understand what the circumstances are that lead up to relapse episodes.

"There is a lot of lore, a lot of which tends to be fairly accurate, such as that people tend to relapse when they are upset," Shiffman says. "But how can you really know that? This is a way to kind of track that in real time." Getting a report in real time is very important, according to Shiffman, because many people who report after the fact tend to be looser with the facts.

"The way our memory and our cognitive apparatus works makes it very hard to be accurate about one's past experience," he explains.

As might be expected, people tend to relapse during periods of stress and emotional upset. However, they also sometimes relapse in what Shiffman calls "positive situations" such as parties or dinners.

Smokers who quit are at the greatest danger for relapse when they are under stress, drinking (alcohol and cigarettes have a strong association) or in a place where other people are smoking and cigarettes are readily available.

Recently, the smoking research group launched a study in which participants are receiving treatment with nicotine patches and monitoring their experiences with computers. The purpose of the study is to compare the effectiveness of different patches and different ways of using those patches.

Since the study is ongoing, Shiffman declined to discuss specifics. He would say only that the study is looking at causes for relapse and craving in the first two weeks after quitting. He also says there are openings in the study for members of the University community who want to quit smoking.

"They get free treatment, both nicotine patches and behavioral counseling," Shiffman says. "In addition, we pay them for participating." Members of the University community who want to kick the habit should call the smoking research group at 383-2054. Volunteers will undergo an interview to determine their eligibility, according to Shiffman, "but the basics are, we are looking for people who want to quit. We'll provide the treatment. In turn, we ask participants to do this monitoring to keep track of their experiences." During the study, participants will be asked to carry one of the research group's small computers for three weeks, one week before they quit and two weeks after they quit.

"I don't smoke, but I've carried it around myself and it's sort of an exercise in self-awareness," Shiffman says. "It gets you thinking about how you are feeling more often than you might otherwise." Although the computers are programmed to beep randomly, participants don't have to worry about being disturbed during an important meeting. Convenience features have been built into the computers that allow users to turn them off while they are in a meeting, driving home, sleeping and so on. "We've actually programmed in an alarm clock," Shiffman notes. "We've even included a snooze button. It's not going to wake you at 3 in the morning. It's manageable."

–Mike Sajna