Adherence to Pharmacological Smoking Cessation Treatment among Weight-Concerned Women

The concern about weight gain that usually accompanies smoking cessation is a substantial impediment to quitting for many women. Given that sustained-released (SR) bupropion is associated with decreased post-cessation weight gain (Jorenby et al., 1999), this pharmacological agent may be particularly effective in improving quit rates among weight-concerned women. Despite the increasing utilization of smoking cessation medications, such as bupropion, relatively little is known about adherence to these regimens. This study examined the rates, predictors, and sequalae of medication adherence among weight-concerned women participating in a 90-day smoking cessation program. In addition to receiving group behavior therapy, participants were randomized to receive either SR bupropion or placebo. Medication adherence was measured over time with electronic pill cap monitors, smoking cessation was measured by self-report and verified with carbon monoxide readings, and several psychosocial variables were assessed with self-report questionnaires. With 112 participants (91% Caucasian; mean age = 43, SD = 10 years), descriptive statistics were computed to summarize medication adherence, and linear and logistic regression analyses were used to predict medication adherence and prolonged smoking abstinence through the end of treatment, respectively. Overall medication adherence was less than optimal throughout the 90-day study period and adherence rates decreased during each successive 30-day period. Depending on the type of summary index, results indicated that medication adherence ranged from 26% to 73% over the 90-day period. Conscientiousness, openness to experience, social support and medication outcome expectancies measured at Week 6 were positively associated with 90-day medication adherence. Independent of medication status, medication adherence predicted increased likelihood of maintaining prolonged smoking abstinence. Follow-up cross-lagged panel design analyses indicated that medication adherence significantly predicted subsequent point-prevalence abstinence. Moreover, openness to experience and Week 6 social support predicted increased likelihood of maintaining prolonged smoking abstinence, and post-hoc analyses indicated that medication adherence mediated the associations between openness to experience and prolonged abstinence, and between Week 6 social support and prolonged abstinence. These results suggest that interventions designed either to modify psychosocial variables associated with medication adherence or to match treatments with individual differences may enhance adherence and possibly improve smoking cessation rates among weight-concerned women