Long-Term Results of a Smoking Reduction Program

Glasgow, Russell E.; Gaglio, Bridget; Estabrooks, Paul A.; Marcus, Alfred C.; Ritzwoller, Debra P.; Smith, Tammy L.; Levinson, Arnold H.; Sukhanova, Anna; O’Donnell, Colin; Ferro, Erica F.

doi:10.1097/mlr.0b013e31817e18d1

Cited by 47 publications

(59 citation statements)

References 18 publications

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“…One was a randomized trial and included a usual care comparison group (29). Though QAs were not reported, the study found that reduction in CPD did not significantly increase point-prevalence abstinence (29). Thus, more research is needed to determine if reduction counseling without NRT increases QAs and abstinence in smokers who are not ready to quit.…”

Section: Introductionmentioning

confidence: 99%

Motivational, reduction and usual care interventions for smokers who are not ready to quit: a randomized controlled trial

et al. 2016

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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.

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Section: Introductionmentioning

confidence: 99%

Motivational, reduction and usual care interventions for smokers who are not ready to quit: a randomized controlled trial

et al. 2016

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“…Only one study included in the review, a smoking cessation study, 87 identified a social ecological approach as the theoretical background for intervention activities, limiting our ability to draw conclusions regarding the usefulness of this theory in promoting maintenance of health behaviors. The paucity of studies referencing an ecological framework was somewhat surprising given the increased focus on using ecological approaches to promote behavior change in recent years.…”

Section: Discussionmentioning

confidence: 99%

Applying Psychological Theories to Promote Long-Term Maintenance of Health Behaviors

Joseph

Daniel

Thind

et al. 2016

American Journal of Lifestyle Medicine

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Behavioral health theory provides a framework for researchers to design, implement, and evaluate the effects of health promotion programs. However, limited research has examined theories used in interventions to promote long-term maintenance of health behaviors. The purpose of this review was to evaluate the available literature and identify prominent behavioral health theories used in intervention research to promote maintenance of health behaviors. We reviewed theories used in intervention research assessing long-term maintenance (≥ 6 months post-intervention) of physical activity, weight loss, and smoking cessation. Five prominent behavioral theories were referenced by the 34 studies included in the review: Self-Determination Theory, Theory of Planned Behavior, Social Cognitive Theory, Transtheoretical Model, and Social Ecological Model. Descriptions and examples of applications of these theories are provided. Implications for future research are discussed.

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“…In summary, including Wu and colleagues' recent finding, two of three trials found reduction interventions without medication for smokers not ready to quit increases cessation in comparison to no treatment [5,7,8]. Whether this is due to the reduction intervention, advice to quit, or both, and whether this is due to increasing QAs or quit success remains unclear.…”

mentioning

confidence: 99%

“…One explanation for this difference is that reducing CPD could be effective by increasing motivation to quit [11] and thus less impactful for those already motivated to quit. Another explanation is that, among smokers who intend to quit now, reducing CPD delays quitting which could decrease motivation to quit [13].In summary, including Wu and colleagues' recent finding, two of three trials found reduction interventions without medication for smokers not ready to quit increases cessation in comparison to no treatment [5,7,8]. Whether this is due to the reduction intervention, advice to quit, or both, and whether this is due to increasing QAs or quit success remains unclear.…”

mentioning

confidence: 99%

“…Interventions to reduce CPD aided by nicotine replacement therapy (NRT) increase quitting among smokers not ready to quit [2], but most smokers do not want to use medications [3]. Although greater self-selected reduction in CPD appears to predict quitting [4], only one [5] of three prior randomized controlled trials (RCT) found that a reduction intervention without medication increased abstinence among smokers not ready to quit [5][6][7]. Wu and colleagues' recent pragmatic RCT contributes to the existing literature with evidence that a very brief reduction intervention (approximately 5 minutes in total) with physician's advice to quit but without medication increases point-prevalence abstinence in comparison to no treatment at a 12-month follow-up (13 versus 7%) [8].…”

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confidence: 99%

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Commentary on Wu et al. (2017): Do very brief reduction interventions increase quitting among smokers not ready to quit?

Klemperer

Hughes

2017

Addiction

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Commentary on Wu et al. (2017): Do very brief reduction interventions increase quitting among smokers not ready to quit?Some smokers unready to quit will quit in response to a brief smoking reduction intervention. Whether this is due to their being more likely to try to quit, more likely to succeed, or both, and whether the intervention's effectiveness is due to reduction, advice to quit, or both is unclear.Most smokers are not ready to quit in the near future, but reducing cigarettes per day (CPD) is common in such smokers [1]. Interventions to reduce CPD aided by nicotine replacement therapy (NRT) increase quitting among smokers not ready to quit [2], but most smokers do not want to use medications [3]. Although greater self-selected reduction in CPD appears to predict quitting [4], only one [5] of three prior randomized controlled trials (RCT) found that a reduction intervention without medication increased abstinence among smokers not ready to quit [5][6][7]. Wu and colleagues' recent pragmatic RCT contributes to the existing literature with evidence that a very brief reduction intervention (approximately 5 minutes in total) with physician's advice to quit but without medication increases point-prevalence abstinence in comparison to no treatment at a 12-month follow-up (13 versus 7%) [8]. We commend the authors for a rigorous test of this important topic in a generalizable setting.One concern is that this study's comparison condition did not include clinician advice to quit smoking, which increases cessation more than no treatment [9]. Thus, it is unclear whether the effectiveness of Wu and colleagues' intervention is due to the reduction intervention, advice to quit, or a combination of the two. This is important, because both prior trials that compared a reduction intervention without medication to advice to quit did not find that reduction increased abstinence [5,6].It is also unclear if the effectiveness of Wu and colleagues' reduction intervention was due to an increased number of quit attempts (QA) or the increased success of QA. This is important, because the processes that prompt making a QA differ from those that engender the success of a QA [10]. The only prior RCT of a reduction intervention without medication that measured QAs found that a reduction intervention did not predict making a QA [6] but self-selected magnitude of reduction did [11]. We know of no trials that have tested the effect of a non-pharmacological reduction intervention on quit success (i.e. abstinence among those who made a QA). An intervention that increases QAs (i.e. initiates behavior) could be useful for those with low motivation to quit or low self-efficacy for quitting. In contrast, an intervention that increases quit success (i.e. maintains behavior) could be useful to overcome barriers to staying quit, such as high dependence, among those already motivated. Knowing which of these was the active ingredient in successful reduction studies is important for knowing who would benefit most from reduction interventions.Import...

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Long-Term Results of a Smoking Reduction Program

Abstract: In the absence of nicotine replacement therapy, the long-term effects of this smoking reduction intervention seem modest and nonsignificant. Future research is indicated to enhance intervention effects and conduct more comprehensive economic analyses of program variations.

Cited by 47 publications

References 18 publications

Motivational, reduction and usual care interventions for smokers who are not ready to quit: a randomized controlled trial

Motivational, reduction and usual care interventions for smokers who are not ready to quit: a randomized controlled trial

Applying Psychological Theories to Promote Long-Term Maintenance of Health Behaviors

Commentary on Wu et al. (2017): Do very brief reduction interventions increase quitting among smokers not ready to quit?

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