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There is much research on the smoking cessation process for adults. Self-help versus counselor-assisted approaches, behavioral versus cognitive strategies, and emotional versus environmental factors have been explored and analyzed in the counseling literature. Zelman, Brandon, Jorenby, and Baker (1992) compared the success of groups in four combinations of counselor-assisted methods, including (a) skills training, [b) support counseling, (c) nicotine gum, and (d) rapid smoking (see Appendix for italicized terms). All four groups reported high initial smoking cessation rates (84% average), with supportive counseling being more effective initially with smokers high in negative affect (emotional distress). Skills training was more helpful at first for those with low negative affect. Rapid smoking helped smokers who use cigarettes as positive reinforcement, whereas the nicotine gum helped those who smoke to alleviate withdrawal. Zelman et al. concluded that counselors should wait until high negative affect clients are past the withdrawal stage before introducing skills training. The 12 month follow-up showed a still respectable 28% to 40% success rate. Combinations of nicotine gum with skills training and nicotine gum with support counseling yielded the highest success rates of 40% and 39%, respectively.
Glasgow, Schafer, and O'Neill (1981) assessed whether it is more effective to use self-help methods or to stop smoking with the assistance of a counselor. The results were mixed. When participants were given a 90- or 154-page book to read to help them stop smoking, most did not stop smoking or even read the materials unless they were also seeing a counselor. Participants were most successful at quitting; however, when given a 20-page, easy-to-read booklet and with no counselor assistance. This result contrasted with many other studies in this review, which indicated that counselor assistance increased success rates.
Orleans et al. (1991) also evaluated the benefits of counselor-assisted smoking cessation attempts, but the assistance was conducted by telephone. Counselor contact boosted quit rates in this study by 50%, causing participants to more closely follow steps outlined in various self-help guides they were given. Successful quitters had more social support, were highly motivated to quit, and had moderate self-efficacy ratings. Quitters used more pre-quitting strategies but not more quitting methods. In fact, Orleans et al. found that those using more than one of the self-help stop-smoking guides were less likely to successfully stop smoking.
Effective strategies for adult cessation have been well documented. Having strong motivation (Glasgow, Klesges, Mizes, & Pechacek, 1985), social support (Mermelstein, Cohen, Lichtenstein, Baer, & Kamarck, 1986; Orleans et al., 1991), and high-perceived self-efficacy (Condiotte & Lichtenstein, 1981; Orleans et al., 1991; Zhu et al., 1996) are factors commonly associated with successful adult smoking cessation. Adults are more likely to choose cognitive strategies and find them easier to use than behavioral strategies (Glasgow et al., 1985). Contact with a counselor improves chances of success, even when contact is brief (Condiotte & Lichtenstein, 1981; Glasgow et al., 1981; Orleans et al., 1991) and when the counselor has little knowledge of how to help someone stop smoking (Jenks, Schwartz, & Dubitzky, 1969).
Adults can benefit from smoking cessation strategies that address the issues that constitute their reasons for smoking. Support from people in a smoker's life, including that of a counselor, can help a smoker develop and sustain the motivation and confidence to successfully stop smoking.
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