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Cancer Control Research

Abstract

This project will identify factors to guide improvements in interventions for maintenance of smoking cessation among patients with lung cancer. Review of the previous proposal (submitted 6/1/99) emphasized its inclusion of too many variables and associated lack of focus and questionable feasibility. In this revision, we have reduced the number of measures from 39 to 20 (48% reduction) and focused the research plan more clearly around specifying the roles in cessation and relapse among lung cancer patients of variables found important in general samples of smokers and ex-smokers. Little research has examined these issues, leaving an important gap in knowledge on which to base efforts to sustain smoking cessation in this high priority group, approximately 50% of whom relapse. During mos 4 - 45, we will enroll 344 patients receiving surgical treatment for stage I and II, non-small cell lung cancer and who smoked within 3 mos preceding referral for surgical evaluation. We will follow these patients at 3, 6, 12, and, as available, 24 and 36 mos post surgery (through 57 rnos of project period). Measures will include variables found important in cessation and maintenance in general samples of smokers and that interventions might address - nicotine dependence, healthy lifestyle, depression, anxiety, social support, and seriousness of disease (including stage, comorbidity, and quality of life). Smoking status will be validated by cotinine and CO. Analyses will evaluate the influence of individual variables on relapse to smoking, mediating and moderating effects among variables, and the fit to observed data of a conceptual model in which variables are organized around two pathways, one based on the personality characteristic of Appetitive Motivation (reward seeking) and associated with Appetitive Urges for cigarettes (anticipation of pleasurable consequences), and one based on Aversive Motivation (negative affect reducing) and associated with Aversive Urges (reduction of negative affect). Thus, results will identify individual variables that are important in relapse and that interventions might address, place understanding of these within broader frameworks of contemporary personality theory, and integrate the individual variables with the broader framework as a basis for identifying individuals likely to benefit from different interventions.