"Prequit attrition" among weight-concerned women smokers.

The impact of concerns about postcessation weight gain is sometimes minimized based on the finding of many (though not all) studies of an association between actual weight gain and successful quitting. A possible explanation is that many weight-concerned individuals either never attempt cessation or terminate their attempts very early, without seeking treatment. To investigate further, we compared attrition after screening and acceptance but prior to the first treatment session of women in two cessation trials, one targeting women with high dieting severity and concerns about body shape, the other not. The trials were similar in length and intensity. As expected, dieting severity scores for the groups were significantly higher for participants in the weight-concerns trial (WCT) than in the trial that did not involve weight concerns (NWCT). Race distribution and Body Mass Index (BMI) did not differ significantly between trials. Compared with the WCT, women accepted into the NWCT were significantly older, significantly more nicotine dependent, smoked significantly more cigarettes per day, and were significantly more depressed. Yet, despite a profile predictive of poorer outcome, "prequit attrition" was significantly lower for NWCT than for WCT (3% vs. 16%). Among WCT participants, those who dropped out scored significantly higher on dieting severity than those reporting for treatment, even after covarying for degree of dependence. To the extent that "prequit attrition" represents a proxy for unwillingness to enter treatment, our findings support the hypothesis that weight concerns constitute a more serious barrier to quitting than is evident simply from looking at treatment outcomes, since these individuals may never make it into the trial samples.