Despite a decline in prevalence of cigarette smoking, it remains the single most important preventable cause of disease morbidity and mortality. Notably, this decline has been much less apparent in women compared with men, and young women are now more likely than men to be smokers. Female smokers are less likely to quit smoking and less successful if they do quit, compared with male smokers. The substantial concern of women about weight gain after quitting is probably a major reason for this gender difference in cessation. Even though amount of weight gain is modest, weight control efforts in conjunction with smoking cessation have been proposed to prevent this weight gain, under the assumption that this will enhance success of cessation. Moreover, many female smokers who quit place themselves on diets to minimize weight gain with cessation. However, recent research results indicate that weight control efforts are associated with no better, and possibly worse, rates of smoking abstinence than smoking cessation interventions without weight control. Given the concern about weight gain and the active weight control efforts by women in conjunction with smoking cessation, a thorough evaluation of whether weight control treatments are helpful or harmful in improving smoking cessation in women is clearly needed. A more effective alternative may be adding cognitive therapy to enhance ability to copy with modest weight gain. The primary focus of this proposal is to examine the influence of dietary manipulations on tobacco withdrawal and smoking cessation in female smokers concerned about weight gain. Two lines of investigation are planned: 1) basic laboratory and inpatient studies to examine the interaction between food intake and smoking or withdrawal under controlled conditions, and 2) a clinical outcome study to determine whether implementation of adjunct weight restriction treatment vs. cognitive therapy to reduce weight-related concerns may enhance or impair success of smoking cessation efforts.
The specific aims are: 1) Examine whether smoking following caloric intake prolongs satiety and reduces subsequent eating (i.e. snacking), and whether this effect is specific to nicotine per se. 2) Evaluate restricted (i.e. dieting) vs ad lib intake of highly- preferred, high-calorie foods on smoking withdrawal, desire to smoke, and mood under controlled inpatient conditions during one week of smoking abstinence. 3) Assess salivary habituation to taste, a measure related to food hedonics and intake, as function of abstinence from smoking or nicotine to determine if attenuated habituation is associated with increased food intake. 4) Determine smoking abstinence rates in women wanting to quit who are given standard 6-week behavioral smoking cessation counseling plus one of three adjunct treatments: a) weight restriction (dieting), b) cognitive therapy aimed at decreasing concern about weight gain, or c) no adjunct. Results of these studies will improve our understanding of the influence of concurrent dieting during smoking cessation on tobacco withdrawal, mood, and cessation, and they will provide specific directions for development of effective adjunct treatments for smoking cessation with female smokers concerned about weight gain.
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