Outcomes of theSmoker’s Health Project: a pragmatic comparative effectiveness trial of tobacco-dependence interventions based on self-determination theory

Abstract

A pragmatic comparative effectiveness trial examined whether extending the duration of a cost-effective, intensive tobacco-dependence intervention designed to support autonomy will facilitate long-term tobacco abstinence. Participants were randomly assigned to one of three tobacco-dependence interventions based on self-determination theory, namely, Intensive Treatment (IT; six contacts over 6 months), Extended Need Support (ENS; eight contacts over 12 months) and Harm Reduction (HR; eight contacts over 12 months with medication use if willing to reduce cigarette use by half). Among participants who completed the interventions, analyses revealed beneficial effects of ENS (15.7 versus 3.8%; χ (1) = 6.92, P< 0.01) and HR (13.6 versus 3.8%; χ (1) = 5.26, P< 0.05), relative to IT, on 12-month prolonged abstinence from tobacco. Also, analyses revealed beneficial effects of ENS (77.7 versus 43.0%; χ (1) = 24.90, P< 0.001) and HR (84.0 versus 43.0%; χ (1) = 37.41, P< 0.001), relative to IT, on use of first-line medications for smoking cessation. Hence, two new interventions were found to be efficacious particularly among participants who completed the interventions. Smokers who stay in treatment for an additional 6 months may benefit from an additional two contacts with practitioners, and thus it seems reasonable for policy makers to offer additional contacts given the health benefits associated with prolonged tobacco abstinence.

Changing Behavior Using Self-Determination Theory

“…For example, Williams et al (2006) trained counselors to support smokers in making autonomous decisions to quit, and Cheon et al (2012) trained teachers to display autonomy-supportive behaviors using their autonomy-support training program. Interventions are usually evaluated using relevant outcome measures of the behavior of interest at single or multiple follow-up occasions after the initiation of the intervention (e.g., Williams et al, 2016). Importantly, researchers have also included measures of key theoretical constructs expected to change as a consequence of the intervention.…”

Written Advice Given by African American Smokers to Their Peers: Qualitative Study of Motivational Messages

“…In our past work in which we collected messages written mostly by non-Hispanic White smokers (32 out of 39 participants) [ 14 ], mindfulness, religious, and spiritual practices did not emerge from the peer-written messages. Although not exclusive to African American communities, use of spiritual and religious practices, as a coping response to health issues, is often adopted in this group [ 40 ], with positive and promising results in health outcomes [ 43 ]. Other health behavior change studies in African American populations have shown more positive outcomes if participants reported having strong ties within a religious congregation [ 41 ].…”

Psychedelics and health behaviour change

“…Self-determined motivation is consistently associated with improved psychological well-being and with engagement with—and persistence in—a variety of tasks and long-term behaviours ( Ntoumanis et al, 2020 ). Consequently, the concept has been explored in studies in health behaviour change, in areas such as dental hygiene ( Halvari et al, 2019 ), diet, exercise and obesity ( Teixeira et al, 2012a ), diabetes ( Phillips and Guarnaccia, 2020 ) and tobacco cessation ( Williams et al, 2016 ), with generally encouraging results ( Leblanc et al, 2016 ; Sheeran et al, 2020 ; Teixeira et al, 2012b ). We propose that it could present a fruitful psychological framework from which to understand how psychedelics could assist in lifestyle change, especially from a motivational viewpoint.…”