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标题：Prospective Predictors of Long-Term Abstinence Versus Relapse Among Smokers Who Quit as Young Adults
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作者：Jonathan T. Macy ; Dong-Chul Seo ; Laurie Chassin 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2007
卷号：97
期号：8
页码：1470-1475
DOI：10.2105/AJPH.2006.101386
语种：English
出版社：American Public Health Association
摘要：Objectives. We sought to identify prospective predictors of long-term abstinence versus relapse among individuals who quit smoking as young adults. Methods. Participants from an ongoing longitudinal study of smoking who had quit for at least 1 year between the ages of 18 and 24 years (n=327) were divided into those who later reported not smoking for more than 5 years (long-term abstinence) or reported current smoking, defined as smoking at least monthly (relapse). Logistic regression was used to examine odds ratios (ORs) of prospective predictors of long-term abstinence versus relapse. Results. Overall, 67% of participants maintained long-term abstinence and 33% relapsed. The strongest predictor of avoiding relapse was marrying a nonsmoker (adjusted OR [AOR]=0.07; 95% confidence interval [CI]=0.03, 0.21). Other predictors included making 1 lifetime quit attempt (AOR=0.13; 95% CI=0.04, 0.44), having as a young adult only 1 parent who smoked (AOR=0.23; 95% CI=0.06, 0.93), and working in a completely smoke-free building (AOR=0.13; 95% CI=0.03, 0.58). Conclusions. The factors related to smoking in the social environment played the largest role in predicting long-term abstinence versus relapse. The recent increase in smoking among young adults in the United States, especially during the 1990s, is a major public health concern. 1 An estimated 11 million young adults in the United States smoke, 2 and most want to quit. 3 ^– 5 Thus, there is a need for a thorough understanding of the factors that promote successful smoking cessation for those aged 18 to 25 years (young adults). Previous studies have reported predictors of cessation among young adults, 4 ^– 10 but there is a lack of consensus about what factors predict cessation in this age group. Moreover, there is no information in the published literature about what predicts long-term success of quitting as a young adult versus relapsing to smoking later in life. We selected participants from an ongoing longitudinal study of the natural history of cigarette smoking who had quit smoking as young adults to identify prospective predictors of maintaining long-term abstinence versus relapsing. We examined demographic factors and predictor variables derived from standard cognitive social psychological models of behavior change (e.g., social cognitive theory, 11 the theory of planned behavior, 12 and the health belief model 13 ) in 4 categories: smoking-related beliefs, smoking-related behaviors, acquisition of adult roles, and smoking in the social environment. Smoking-related beliefs and behaviors may play a role in predicting successful cessation among young adults. Previous studies have identified perceived likelihood to continue smoking 6 ^, 9 and valuing a healthy lifestyle 6 as the factors associated with cessation. Smoking-related behaviors such as heavy smoking and nicotine dependence were observed in young adult smokers who were less likely to quit. 6 ^, 7 Also, although 1 study identified age of onset of smoking as a significant predictor of cessation, 7 another did not. 6 Accordingly, our study examined personally relevant beliefs about psychological and health consequences of smoking and generalized beliefs about the negative health effects of smoking. For smoking-related behaviors, we assessed greatest number of cigarettes ever smoked, smoking onset, and age of quitting during young adulthood as predictors of maintaining long-term abstinence versus relapsing. The acquisition of adult roles is another important factor that may influence cessation success. For example, young adults who get married are more likely to quit smoking. 10 ^, 14 What may be even more important, however, is formal marriage to a nonsmoker, because studies have reported that marriage itself or cohabitating with a nonsmoker did not have an association with smoking cessation, but marrying a nonsmoker facilitated quitting. 5 ^, 6 ^, 8 There is consensus in the literature that living with children is not associated with short-term cessation success. 5 ^, 6 ^, 8 ^, 10 Two studies found that those who were employed were more successful at quitting, 6 ^, 10 whereas another found no association with employment. 8 We tested the influence of taking on adult roles on long-term cessation success by including marriage experience and having children as predictor variables. Finally, the social environment has consistently been shown to correlate strongly with cessation during young adulthood. Smokers were less likely to quit if they perceived a higher prevalence of smoking 6 and if they had greater exposure to peers who smoked. 5 ^, 6 ^, 8 ^, 9 Restrictions on smoking in the workplace have also been associated with cessation, 15 ^, 16 but no study has focused specifically on the effect of smoke-free workplace policies on quitting among young adult smokers. In addition, previous research has examined the effect of parental smoking, which could indicate genetic as well as environmental risk, on cessation. In 2 studies of cessation during young adulthood, parental smoking had no relation with cessation. 6 ^, 8 However, other research has found that individuals whose parents smoked were less likely to quit smoking. 10 We examined perceived prevalence of smoking; smoking among friends, parents, and spouses; and smoking in the workplace as predictors. Although factors in these 4 conceptual categories have been shown in some studies to be important predictors of cessation for young adults, the previous research relied on relatively short follow-up periods to assess cessation success. We used a longitudinal data set to explore predictors of long-term success of quitting during young adulthood. A better understanding of the factors that are associated with relapse later in life provides much-needed guidance on how to prevent relapse among young adults who have quit smoking.