Effects of stage-matched repeated individual counseling on smoking cessation: A randomized controlled trial for the high-risk strategy by lifestyle modification (HISLIM) study

Abstract

Objective: The purpose of this study was to evaluate the effects of stage-matched repeated individual behavioral counseling as an intervention for the cessation of smoking.Methods: We conducted a multisite randomized controlled trial that enrolled smokers unselected for their readiness to quit. There were 979 smokers with hypertension or hypercholesterolemia recruited from 72 study sites and randomly allocated to the intervention or control group. Smokers in the intervention group received stage-matched individual counseling consisting of a 40 minute initial session and four 20-30 minute follow-up sessions. Smokers in the control group received individual behavioral counseling for hypertension or hypercholesterolemia.Results: The point prevalence abstinence rate at 6 months, validated by carbon monoxide testing, in the intervention group (13.6%) was 5.4 times higher (p<0.001) than that in the control group (2.5%). When the data were analyzed based on the baseline stage of change, there were significant differences in the abstinence rates at 6 months in smokers versus controls with each stage of change except in immotives. The odds ratio was 6.4 (p<0.001) in precontemplators, 6.7 (p<0.001) in contemplators, and 6.2 (p<0.01) in preparators. There was a positive, consistent effect of the intervention regardless of study site (worksite or community) or the presence of hypertension or hypercholesterolemia.Conclusions: We showed the effects of an intervention with repeated individual behavioral counseling on the cessation of smoking in smokers unselected for their readiness to quit. This result suggests that stage-matched individual counseling, based on the transtheoretical model, is effective in smokers with a lower motivation to quit as well as those ready to quit.

Identifying Evidence-Based Competences Required to Deliver Behavioural Support for Smoking Cessation

“…"Effective" was defined as a risk ratio for smoking cessation at follow-up for intervention versus control conditions of ≥1.50 and the difference between conditions being significant at p<0.05. Four interventions for individual [20][21][22][23] and eight for groupbased behavioural support [24][25][26][27][28][29][30][31] were identified in this way. Behaviour change techniques within these interventions were identified from published study reports using an established taxonomy of smoking behaviour change techniques (Michie et al, submitted).…”

Continuation of Smoking Cessation and Following Weight Change after Intervention in a Healthy Population with High Smoking Prevalence

“…There have been several reports in Japan on the effectiveness of smoking cessation intervention in randomized controlled designs 2,3) . In Western countries, there have been many reports on interventions for volunteer participants or patients in clinical settings 4,5) .…”

Nicotine Dependence and Cost-Effectiveness of Individualized Support for Smoking Cessation: Evidence from Practice at a Worksite in Japan

“…In particular, our study group appeared to be well-motivated to stop smoking as evidenced by their voluntary rather than mandatory participation in the program. In contrast, at clinics or hospitals, unmotivated smokers who merely followed the advice of their physicians may also have attempted to quit smoking [30], ultimately leading to a decrease in success rate [13], [30]. In addition, many subjects attempting to quit smoking at clinics or hospitals may have various diseases [30], such as mental disorders, which may lead to difficulty in cessation [30].…”

“…It is likely that some of our study participants may have successfully stopped smoking without our support (i.e., natural quitters) [13], [25]. It is therefore necessary to evaluate the net cost-effectiveness, taking into account individuals who stopped smoking unassisted.…”