One Rutgers, A World of Discovery: This story is part of an ongoing Rutgers series looking at emerging collaborations, across a wide range of disciplines, at the new Rutgers.
The first time Marika O’Rourke quit smoking 15 years ago, she tried one form of treatment – a smoking cessation drug called Zyban.
It worked for nine months before O’Rourke, a 59-year-old Franklin Township resident, began having an after-breakfast cigarette, and then an after-lunch cigarette, until eventually she was smoking more than a pack a day.
In August, O’Rourke enrolled in the Rutgers’ Tobacco Dependence Program clinic, where doctors suggested a combination of cessation methods, including behavioral changes and a nicotine patch.
Since then, she’s gone more than six weeks without a cigarette and is now part of a collaborative study which may help clinicians create customized treatments that work from day one. The research pools the knowledge of Rutgers experts from the Cancer Institute of New Jersey, the Robert Wood Johnson Medical School, the School of Public Health and the Department of Psychology in the School of Arts and Sciences.
When it comes to helping smokers kick the habit, one size doesn’t fit all. Discovering what influences an individual’s decision to light up – and what strategy works best for them – is the key to successful treatment. And it’s often a process of trial and error.
Working across disciplines, the clinicians seek to gain a multifaceted perspective on the forces that create and sustain a smoking addiction. They also hope to shed light on an essential question: Why can some people, but not others, quit for good?
Tailoring Intervention To Individual Needs
The new research examines factors such as impulsivity, persistence, how smokers respond to tobacco company marketing tactics and whether they’ve used new products like electronic cigarettes and dissolvable tobacco.
“Tobacco treatment affects so many aspects of a person’s life,’’ says Michael Steinberg, a physician and director of the Tobacco Dependence Program, which began in 2000 at the former University of Medicine and Dentistry of New Jersey (UMDNJ).
“You don’t just deal with the medical condition, you look at where they live, what kind of resources they have, what kind of products they’re exposed to. Are they getting email coupons for cigarettes? And is that what’s leading them back to smoking?,” Steinberg adds. “If you can answer these questions, you can tailor an intervention to their particular needs. This is personalizing medicine.’’
As part of the study, physicians and public health experts are working with Danielle McCarthy, a Rutgers psychologist who specializes in the behavioral aspects of smoking addiction and cessation.
When integration talks began last year between Rutgers and the former UMDNJ, the researchers sketched out plans for a holistic study of smokers that would incorporate all of their expertise. Rutgers integrated in July with most of the schools, centers and institutions that made up UMDNJ.
“It makes a research program so much stronger when people doing similar work can come at a problem from multiple vantage points,’’ says Marc Steinberg, an assistant professor of psychiatry at Robert Wood Johnson Medical School. “It allows us to identify more solutions.’’
Although the number of smokers has slowly and steadily declined over the years, tobacco kills more than 430,000 annually. “It’s the leading cause of preventable death in our society,’’ says Tobacco Dependence Program director Michael Steinberg.
His clinic treats patients through a combination of individual counseling and support groups. The program also focuses on advocacy and research.
An important part of the study includes research on marketing techniques and how alternative cigarette and tobacco products affect efforts to quit smoking. “If people can’t smoke, are they switching to smokeless products? Do products like this make it harder for people to quit smoking?’’ asks Steinberg.
Those questions will be explored by Cristine Delnevo, Chair of Health Education and Behavioral Science at the School of Public Health and co-leader of the Cancer Prevention and Control Research Program at the cancer institute. Joining her is Jane Lewis, an associate professor of Health Education and Behavioral Science at the School of Public Health.
The overall study, which is funded by the cancer institute, involves 250 subjects, who will answer survey questions and participate in a series of tests run by McCarthy and Marc Steinberg. They are studying impulsivity, distress tolerance and task persistence, qualities they believe are predictors of a smoker’s risk of relapse.
In one of McCarthy’s studies, which measures impulsivity, participants must choose between receiving $100 in a week’s time or $22 on the spot. Initially, nearly all chose to wait, she says. But in a second offer, the $22 figure is changed to $76. “People with lower impulse control will say, ‘oh, that’s close enough’ and take the $76,’’ she says.
In another study, subjects are isolated for 15 minutes with a lighter, cigarettes and an ashtray. Their choice is to smoke two cigarettes within 15 minutes or wait an hour and get four cigarettes.
“We wanted to measure how impulsive they were in real time in a more natural environment,’’ says McCarthy. “The most impulsive people were the ones more likely to smoke within the first couple of minutes ... But people aren’t equally impulsive all the time. They might be more impulsive when they’re crabby, tired or they’ve been drinking. Smoking is highly variable across situations and times. What does this mean in terms of treatment?’’
Marc Steinberg performs a study where subjects trace a pattern’s mirrored reflection on a computer screen to test how they’re able to persist with a difficult task. “How long people stick with something, even when it’s frustrating, is analogous to what happens when people try to quit smoking,’’ he says. “People who score higher on those traits might need the most proactive support, like telephone counseling, or they might need booster sessions more often...While it’s important for all smokers to seek counseling and use one of the seven FDA approved medications for cessation, it may be especially important for those with lower persistence."
O’Rourke, who now has more energy on her daily bike rides – and no longer feels like a social “pariah,’’ sneaking out for cigarettes – knows firsthand how tough quitting can be.
She agreed to be part of the study so that, someday, it might be easier for people like her to remain smoke free. “The more tools you have, and the more assistance, the more successful you’ll be,’’ O’Rourke says.