This study provides a prospective fine-grain description of the incidence and pattern of intentions to quit, quit attempts, abstinence, and reduction in order to address several clinical questions about self-quitting.

Aims To test whether, in comparison to usual care, brief motivational or reduction interventions increase quit attempts (QA) or abstinence among smokers who are not ready to quit. Design A parallel-group randomized controlled trial of brief motivational (n=185), reduction (n=186), or usual care (n=189) telephone interventions delivered over the course of 4 weeks. Outcomes were assessed at 6- and 12-month follow-ups. No medication was provided. Setting United States. Participants 560 adult smokers of ≥ 10 cigarettes per day who were not ready to quit in the next 30 days. Measurements The primary outcomes were whether participants made a QA that lasted ≥ 24 hours and whether they made a QA of any length between baseline and 6-months. Secondary outcomes included 7-day point-prevalence abstinence at 6- and 12-months. The 12-month follow-up was added after the study began. Findings A-priori defined comparisons were between motivational versus usual care and reduction versus usual care conditions. The probability of making a QA that lasted ≥ 24 hours was not significantly different between the motivational (38%) or the reduction (31%) conditions and the usual care (34%) condition (motivational versus usual care odds ratio (OR)=1.19 95% confidence interval (CI)=0.78 to 1.82; reduction versus usual care OR=0.89 95% CI=0.57 to 1.36). Bayes factors ranged from 0.13 to 0.18. Findings regarding a QA of any length were similar. At 6 months, the motivational condition had marginally more abstinence than usual care (11% versus 5% OR=2.17 95% CI=0.99 to 4.77) but the reduction condition was not significantly different from usual care (8% versus 5% OR=1.57 95% CI=0.69 to 3.59). At 12 months, the motivational condition had significantly more abstinence than usual care (10% versus 4% OR=2.80 95% CI=1.14 to 6.88) and the reduction condition had marginally more abstinence than usual care (9% versus 4% OR=2.45 95% CI=0.98 to 6.09). Conclusions Among adult smokers who are not ready to quit, both logistic regression and Bayesian analysis indicate that neither motivational nor reduction-based telephone interventions increased the odds of making a quit attempt in comparison to usual care at 6 months. The motivational intervention appeared to increase abstinence at 6 months and did increase abstinence at 12 months. The reduction intervention did not increase abstinence at 6 months but appeared to increase abstinence at 12 months.

Introduction: Nicotine replacement therapy to aid smoking reduction increases the probability of a future quit attempt among smokers not currently planning to quit smoking. We tested whether varenicline, a partial nicotine agonist, would also increase future quit attempts. Methods:This randomized, placebo-controlled trial recruited 218 smokers who were interested in quitting but had no plans to quit in the next month. Participants used varenicline (2 mg/day) or placebo for 2-8 weeks plus received brief counseling on methods to reduce cigarettes/day. The primary measure was the incidence of a quit attempt within 6 months of study entry. Secondary measures were point prevalence abstinence, motivation to stop smoking, and reduction in cigarettes/day. Results:Varenicline increased the incidence of a quit attempt more than placebo at the Nebraska site (73% vs. 41%; p < .001) but not at the Vermont site (45% vs. 51%; p = .45). Varenicline increased most other measures of quit attempts, motivation and abstinence, independent of site. The beneficial effects of varenicline in quit attempts appeared to be mediated by greater reductions in cigarettes/day, dependence, craving, and cigarette satisfaction. Varenicline had a greater effect on quit attempts in less-dependent smokers, in minority smokers, and in those who had less prior cessation or reduction activity. Adverse events were minimal. Conclusions:Varenicline increased quit attempts in smokers who are not currently trying to quit at one of the two study sites and improved most all secondary outcomes independent of site. This appeared to be due to decreasing cigarettes/day and level of dependence.

Background Most of the harm from marijuana use is experienced by daily users. Despite this, there has not been a detailed prospective description of daily marijuana use. Methods We recruited daily marijuana users (n=142) by internet ads, Craigslist, flyers, etc. Participants were mostly women (58%) with a mean age of 33 and 47% were minorities. Participants called an Interactive Voice Response phone system to report marijuana and other drug use daily for 3 months. Results Participants averaged using marijuana 3.2 times per day. Almost all participants used multiple modes of delivery during the study. Bongs/vaporizers/pipes was the most common mode of use (45% of uses). Day-to-day variability in amount of use was relatively small. The median rating of intoxication was 3.8 on a 0-6 scale with no intoxication reported on 1% of days and severe intoxication on 24% of days. The large majority binge drank (71%) or used tobacco (73%). Fifteen during-study variables were associated with the frequency of marijuana use; running out of marijuana and social setting were the strongest correlates. Retrospective reports of “usual” use at study entry were often significantly different than daily reports of use during the study. Conclusions This is the first detailed prospective description of daily marijuana use. Most users used multiple times/day, used multiple modes to administer marijuana, were often intoxicated, and under-reported high rates of using alcohol and tobacco. The frequency of marijuana use was especially influenced by social factors. These results will help future studies better describe daily marijuana use.

BACKGROUND In a prior study, we found changing tobacco use was more complex than previously thought, with users often transitioning between intending to quit and not intending to quit, and among typical use, abstinence, and reduction, on multiple occasions. The current study attempted to replicate those results. METHODS A convenience sample of 40 tobacco smokers who intended to quit within the next 3 months called in nightly for 28 days to an Interactive Voice Response system to report cigs/day and daily intentions to smoke or not for the next day. We provided no treatment. RESULTS Within the month of the study, 32% of smokers had multiple episodes of intentions to not smoke, and 64% transitioned among smoking as usual, abstinence, and reduction status on multiple occasions. When participants reported they intended to not smoke the next day, 56% of the time they did not make a quit attempt the next day. Just under half (44%) of quit attempts occurred on days with no intentions to quit the night before. Most quit attempts (69%) lasted less than a day. Reduction in cigs/day was as common as abstinence. CONCLUSIONS Our prospective results replicated retrospective findings that most attempts to stop smoking result in a complex pattern of changes in smoking. These results suggest future research on treatments that can accommodate a) multiple quit attempts over a short period, b) reduction episodes, c) unplanned quit attempts, and d) immediate relapse.