Delivery and Impact of a Motivational Intervention for Smoking Cessation: A PROS Study

Abstract

OBJECTIVES: We tested a Public Health Service 5As-based clinician-delivered smoking cessation counseling intervention with adolescent smokers in pediatric primary care practice. METHODS: We enrolled clinicians from 120 practices and recruited youth (age $14) from the American Academy of Pediatrics Pediatric Research in Office Settings practice-based research network. Practices were randomly assigned to training in smoking cessation (intervention) or social media counseling (attentional control). Youth recruited during clinical visits completed confidential screening forms. All self-reported smokers and a random sample of nonsmokers were offered enrollment and interviewed by phone at 4 to 6 weeks, 6 months, and 12 months after visits. Measures included adolescents' report of clinicians' delivery of screening and counseling, current tobacco use, and cessation behaviors and intentions. Analysis assessed receipt of screening and counseling, predictors of receiving 5As counseling, and effects of interventions on smoking behaviors and cessation at 6 and 12 months. RESULTS: Clinicians trained in the 5As intervention delivered more screening (b = 1.0605, P , .0001) and counseling (b = 0.4354, P , .0001). In both arms, clinicians more often screened smokers than nonsmokers. At 6 months, study arm was not significantly associated with successful cessation; however, smokers in the 5As group were more likely to have quit at 12 months. Addicted smokers more often were counseled, regardless of study arm, but were less likely to successfully quit smoking. CONCLUSIONS: Adolescent smokers whose clinicians were trained in 5As were more likely to receive smoking screening and counseling than controls, but the ability of this intervention to help adolescents quit smoking was limited. WHAT'S KNOWN ON THIS SUBJECT: Tobacco use is a significant health issue for adolescents. Pediatricians have an opportunity to screen and counsel youth about smoking. There is limited evidence that brief cessation counseling for adolescent smokers results in cessation attempts or sustained abstinence. WHAT THIS STUDY ADDS: In a 5As randomized control trial for adolescent smokers, intervention clinicians provided more screening and counseling than those in the control group; adolescents who received interventions more often tried to quit. Nicotine addiction was the strongest predictor of continued smoking.

Gender Differences in the Interrelations Among Social Support, Stressful Life Events, and Smoking Cessation in People With Severe Mental Illnesses

“…Our study finding suggests that females with SMI might benefit from smoking cessation programs developed to improve total, appraisal, and tangible social support, which in turn could increase the likelihood of smoking cessation. These programs might include interventions focusing on improving family, financial, emotional, and environmental support (Aschbrenner et al, 2017; Dickerson et al, 2013; van Wijk et al, 2019), romantic partner dyads (Lüscher & Scholz, 2017; Whitton et al, 2020), supportive peers (van den Brand et al, 2019; White et al, 2020), group interventions (Naslund et al, 2017; Wang et al, 2019), one-on-one counseling (Byaruhanga et al, 2020; Fiore, 2008; Klein et al, 2020), support groups (Soulakova et al, 2018), and Internet or Web-based interventions with peer support (Brunette et al, 2017; Graham et al, 2017; Villanti et al, 2020). These interventions are considered evidence based and cost effective (Bernstein et al, 2016; de Dios et al, 2016; Soulakova et al, 2018).…”

Cross-sectional online survey of clinicians’ knowledge, attitudes and challenges to screening and counselling adolescents and young adults for substance use

“…The study population included adolescent healthcare clinicians including general internal medicine physicians, paediatricians and family medicine physicians who care for adolescent and young adult patients. Clinicians from several sample frames were recruited and surveyed: 1203 members of the Society for Adolescent Health and Medicine (SAHM); 335 participants in a prior randomised control trial (ClinicalTrials.gov NCT01312480; post-results) of adolescent tobacco cessation conducted through Paediatric Research in Office Settings, the primary care practice-based research network of the American Academy of Paediatrics, 28 called the “Adolescent Health in Pediatric Practice” (AHIPP) sample; and 700 physicians from the AAFP’s Member Insight Group (currently called the Member Insight Exchange). In addition to these professional societies, substance and tobacco use researchers were identified using convenience sampling from the investigators’ research networks at 12 institutions (Stanford; University of California San Francicso (UCSF); University of Texas (UT) Health Sciences Center; University of Florida; Vanderbilt University Medical Center; University of Massachusetts, Worchester; University of California Los Angeles (UCLA); Dartmouth; Children’s Hospital of Philadelphia; Johns Hopkins; University of Michigan; Columbia University) and were asked to distribute the survey to all clinical departments serving adolescent and young adult patients.…”