Identifying Optimal, Translatable Treatment Components for Increasing Smokers’ Motivation to Quit

Abstract

Most smokers are not willing to engage in cessation treatment at a given point in time. Recent data suggest that the downward trend in adult smoking prevalence might be stalling. Discouragingly, the proportion of everyday smokers who made a quit attempt during the preceding year decreased 7.2 percentage points from 1933 (47.0%) to 2007 (39.8%). Finding ways to motivate and to mobilize smokers to quit is critical to our efforts to reduce the prevalence of cigarette smoking. The overall goal of this study is to identify effective interventions aimed at increasing use of cessation services. This study evaluates interventions for smoking not currently willing to make a quit attempt. Building on intervention components that show promise empirically and theoretically (pharmacotherapy, behavioral interventions, and motivational interviewing), and using innovative research designs to evaluate both individual and combined treatment components, the specific aims are as follows:

  1. Implement a randomized, factorial experiment to identify which intervention components increase motivation to quit, quit attempts, and use of evidence-based cessation strategies or services
  2. Determine which treatment effects, assessed using intensive longitudinal data (ILD), mediate intervention outcomes

The design of this study is a 2X2X2X2X randomized factorial experiment, resulting in 16 experimental, fully-crossed conditions. The four independent variables (and their levels/values) are:

  1. Patch NRT (patch or no patch)
  2. Ad lib (gum or lozenge) NRT (ad lib NRT or no ad lib NRT)
  3. Behavioral training in smoking reduction and practice quit attempts (training or no training)
  4. Motivational interviewing (MI) (MI or no MI)

The total sample size is N = 640 or N = 40 per experimental condition. Participants are smokers recruited through primary care settings who are currently not interested in stopping smoking, and are randomly assigned to one of the 16 possible conditions. All participants are attending an initial in-person assessment visit, and then subsequent assessments are conducted by telephone over a 52-week period. All interventions (either single or combination components) are delivered by clinic case managers over a 6-week period. In each case, the initial “treatment” session or orientation to treatment occurs during the sole in-person clinic visit, and the remaining contacts are via telephone. Over the course of the 6-week treatment period, participants complete evening phone-prompted assessments every other night, to measure hypothesized mediators of treatment effects. Using diverse data (e.g., effect sizes, attrition, utilization, cost-effectiveness) and working with the Optimization Core, we are selecting optimal intervention conditions for further testing. Thus, this study is a first step in evaluating which specific prequit intervention components, either singly or in combination, boost both quit attempts and use of evidence-based cessation interventions. The results of this study support the development of a chronic care approach to tobacco dependence intervention that is designed to benefit every tobacco user, including those who are unmotivated to launch a quit attempt.

Affiliated Center/Program

Principal investigator
Funding Agency

National Cancer Institute of the National Institutes of Health (Grant No. P50CA143188) through the University of Wisconsin at Madison

Start date
10/15/2009
End date
09/30/2014
Total award
$1,184,150
About this grant

This research is part of a program project of the University of Wisconsin's Center for Tobacco Research and Intervention.

Parent Study
Engineering Effective Interventions for Tobacco Use: A Translational Laboratory
PI of Parent Study
Michael C. Fiore, MD, and Timothy B. Baker, PhD
University of Wisconsin at Madison

Related publications


See the publications supported by this grant on this PubMed list

Piper ME, Fiore MC, Smith SS, Fraser D, Bolt DM, Collins LM, Mermelstein R, Schlam TR, Cook JW, Jorenby DE, Loh WY, Baker TB. Identifying effective intervention components for smoking cessation: a factorial screening experiment. Addiction. 2016 Jan;111(1):129-41. [See abstract.]

Cook JW, Collins LM, Fiore MC, Smith SS, Fraser D, Bolt DM, Baker TB, Piper ME, Schlam TR, Jorenby D, Loh WY, Mermelstein R. Comparative effectiveness of motivation phase intervention components for use with smokers unwilling to quit: a factorial screening experiment. Addiction. 2016 Jan;111(1):117-28. [See abstract.]

Baker TB, Collins LM, Mermelstein R, Piper ME, Schlam TR, Cook JW, Bolt DM, Smith SS, Jorenby DE, Fraser D, Loh WY, Theobald WE, Fiore MC. Enhancing the effectiveness of smoking treatment research: conceptual bases and progress. Addiction. 2016 Jan;111(1):107-16. [See abstract.]

Schlam TR, Fiore MC, Smith SS, Fraser D, Bolt DM, Collins LM, Mermelstein R, Piper ME, Cook JW, Jorenby DE, Loh WY, Baker TB. Comparative effectiveness of intervention components for producing long-term abstinence from smoking: a factorial screening experiment. Addiction. 2016 Jan;111(1):142-55. [See abstract.]

Collins LM, Trail JB, Kugler KC, Baker TB, Piper ME, Mermelstein RJ. Evaluating individual intervention components: making decisions based on the results of a factorial screening experiment. Transl Behav Med. 2014 Sep;4(3):238-51. [See abstract.]

Schlam TR, Fiore MC, Smith SS, Fraser D, Bolt DM, Collins LM, Mermelstein R, Piper ME, Cook JW, Jorenby DE, Loh WY, Baker TB. Comparative effectiveness of intervention components for producing long-term abstinence from smoking: a factorial screening experiment. Addiction. 2016 Jan;111(1):142-55. [See abstract.]

Baker TB, Collins LM, Mermelstein R, Piper ME, Schlam TR, Cook JW, Bolt DM, Smith SS, Jorenby DE, Fraser D, Loh WY, Theobald WE, Fiore MC. Enhancing the effectiveness of smoking treatment research: conceptual bases and progress. Addiction. 2016 Jan;111(1):107-16.  [See abstract.]

Piper ME, Baker TB, Mermelstein R, Collins LM, Fraser DL, Jorenby DE, et al. Recruiting and engaging smokers in treatment in a primary care setting: developing a chronic care model implemented through a modified electronic health record. Transl Behav Med. 2013 Sep;3(3):253-63. [See abstract.]

Piper ME, Baker TB, Mermelstein R, Collins LM, Fraser DL, Jorenby DE, Smith SS, Christiansen BA, Schlam TR, Cook JW, Oguss M, Fiore MC. Recruiting and engaging smokers in treatment in a primary care setting: developing a chronic care model implemented through a modified electronic health record. Transl Behav Med. 2013 Sep;3(3):253-63. [See abstract.]

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