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Comparative effectiveness of motivation phase intervention components for use with smokers unwilling to quit: a factorial screening experiment.

ABSTRACT: AIMS:To screen promising intervention components designed to reduce smoking and promote abstinence in smokers initially unwilling to quit. DESIGN:A balanced, four-factor, randomized factorial experiment. SETTING:Eleven primary care clinics in southern Wisconsin, USA. PARTICIPANTS:A total of 517 adult smokers (63.4% women, 91.1% white) recruited during primary care visits who were willing to reduce their smoking but not quit. INTERVENTIONS:Four factors contrasted intervention components designed to reduce smoking and promote abstinence: (1) nicotine patch versus none; (2) nicotine gum versus none; (3) motivational interviewing (MI) versus none; and (4) behavioral reduction counseling (BR) versus none. Participants could request cessation treatment at any point during the study. MEASUREMENTS:The primary outcome was percentage change in cigarettes smoked per day at 26?weeks post-study enrollment; the secondary outcomes were percentage change at 12 weeks and point-prevalence abstinence at 12 and 26 weeks post-study enrollment. FINDINGS:There were few main effects, but a significant four-way interaction at 26?weeks post-study enrollment (P?=?0.01, ??=?0.12) revealed relatively large smoking reductions by two component combinations: nicotine gum combined with BR and BR combined with MI. Further, BR improved 12-week abstinence rates (P?=?0.04), and nicotine gum, when used without MI, increased 26-week abstinence after a subsequent aided quit attempt (P?=?0.01). CONCLUSIONS:Motivation-phase nicotine gum and behavioral reduction counseling are promising intervention components for smokers who are initially unwilling to quit.

SUBMITTER: Cook JW

PROVIDER: S-EPMC4681585 | biostudies-literature | 2016 Jan

REPOSITORIES: biostudies-literature

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Comparative effectiveness of motivation phase intervention components for use with smokers unwilling to quit: a factorial screening experiment.

Cook Jessica W JW Collins Linda M LM Fiore Michael C MC Smith Stevens S SS Fraser David D Bolt Daniel M DM Baker Timothy B TB Piper Megan E ME Schlam Tanya R TR Jorenby Douglas D Loh Wei-Yin WY Mermelstein Robin R

Addiction (Abingdon, England) 20151119 1

<h4>Aims</h4>To screen promising intervention components designed to reduce smoking and promote abstinence in smokers initially unwilling to quit.<h4>Design</h4>A balanced, four-factor, randomized factorial experiment.<h4>Setting</h4>Eleven primary care clinics in southern Wisconsin, USA.<h4>Participants</h4>A total of 517 adult smokers (63.4% women, 91.1% white) recruited during primary care visits who were willing to reduce their smoking but not quit.<h4>Interventions</h4>Four factors contrast ...[more]

PMID: 26582140

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Project description:IntroductionMost people who smoke cigarettes are not willing (ie, not ready) to make a quit attempt (QA) at any given time. Unfortunately, interventions intended to increase QAs and the success of QAs are only modestly effective. Identifying processes leading to QAs and quitting success could guide intervention development.Aims and methodsThis is a secondary analysis of a randomized factorial trial of 6 weeks of motivation-phase interventions among primary care patients (N = 517) who were initially unwilling to quit but were willing to reduce their smoking. Using logistic regression, we controlled for treatment condition and tested whether baseline or change in smoking-related constructs after 6 weeks of treatment predicted (1) making an at least 24 h QA between weeks 6 and 26 and (2) quitting success at week 26 (7-day point-prevalence abstinence among those who made a QA). Predictors included cigarettes/day, time to first cigarette, motivation to quit, quitting self-efficacy, anticipated urges to smoke if quit, positive affect, negative affect, and time spent around others who smoke.ResultsIn multivariable models that included all smoking-related constructs, changes in the following variables predicted initiating a QA above and beyond other variables: greater baseline time to first cigarette (odds ratio [OR] = 1.60), increases in time to first cigarette (OR = 1.27), and increases in quitting self-efficacy (OR = 1.14). Increased motivation to quit predicted conversion of a QA into quitting success at 26 weeks (OR = 1.36).ConclusionPredictors of making a QA differed from predictors of quitting success. Predictors of QAs and success could each serve as important treatment targets of motivation-phase interventions.ImplicationsMotivation-phase interventions for people initially unwilling to quit smoking cigarettes may be improved by striving to increase their (1) time to first cigarette and quitting self-efficacy to promote QAs and (2) motivation to quit to promote quit success. Future experimental tests of such interventions are needed to identify causal determinants of QAs and quitting success.

Project description:BackgroundThe promotion of smoking cessation within lung cancer screening could lead to benefits for smoking-related disease and improve cost-effectiveness of screening. Little is known about how smokers respond to lung cancer screening and how this impacts smoking behaviour. We aimed to understand how lung cancer screening influences individual motivations about smoking, including in those who have stopped smoking since screening.MethodsThirty one long-term smokers aged 51-74 took part in semi-structured interviews about smoking. They had been screened with the EarlyCDT-Lung Test (13 positive result; 18 negative) as part of the Early Cancer Detection Test Lung Cancer Scotland Study. They were purposively sampled for interview based on their self-reported post-screening smoking behaviour. Eleven participants had stopped smoking since screening. Verbatim interview transcripts were analysed using thematic analysis.ResultsTwo key overarching themes were interpretations of screening test results and emotional responses to those interpretations. Participants' understanding of the risk implied by their test result was often inaccurate, for example a negative result interpreted as an 'all-clear' from lung cancer and a positive result as meaning lung cancer would definitely develop. Those interpretations led to emotional responses (fear, shock, worry, relief, indifference) influencing motivations about smoking. Other themes included a wake-up call causing changes in perceived risk of smoking-related disease, a feeling that now is the time to stop smoking and family influences. There was no clear pattern in smoking motivations in those who received positive or negative test results. Of those who had stopped smoking, some cited screening experiences as the sole motivation, some cited screening along with other coinciding factors, and others cited non-screening reasons. Cues to change were experienced at different stages of the screening process. Some participants indicated they underwent screening to try and stop smoking, while others expressed little or no desire to stop.ConclusionsWe observed complex and individualised motivations about smoking following lung cancer screening. To be most effective, smoking cessation support in this context should explore understanding of screening test results and may need to be highly tailored to individual emotional responses to screening.

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Comparative effectiveness of motivation phase intervention components for use with smokers unwilling to quit: a factorial screening experiment.

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Comparative effectiveness of motivation phase intervention components for use with smokers unwilling to quit: a factorial screening experiment.

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