Offering smoking treatment to primary care patients in two Wisconsin healthcare systems: Who chooses smoking reduction versus cessation?

Abstract

Smokers unwilling to make a quit attempt can still benefit from smoking intervention. However, it is unclear what proportion of smokers will enter such a Motivation phase intervention, and whether such an intervention attracts different types of smokers than does abstinence oriented treatment. We conducted a study from June 2010 to October 2013 based on a chronic care model of tobacco treatment among study eligible primary care patients (N=1579; 58% women, 89% White) presenting for regular health care visits in southern Wisconsin, U.S. Medical assistants, prompted via the electronic health record (EHR), invited smokers (n=10,242) to learn more about treatment options to help them either reduce their smoking or quit. Of those invited to learn more who were then reached by study staff, 10.2% (n = 1046) reported interest in reduction treatment and 24% (n = 2465) reported interest in cessation treatment. Patients who selected and ultimately entered reduction (n=492) versus cessation (n=1087) were more likely to report: older age; a history of anxiety; lower motivation to quit; lower primary dependence motives; more close friends or family who smoke; and a greater interval since their last quit attempt (ps<.05). Results suggest that Motivation phase treatment aimed at smoking reduction may increase the proportion and range of smokers inducted into tobacco treatment.

Effects of motivation phase intervention components on quit attempts in smokers unwilling to quit: A factorial experiment

“…It is possible that such smokers previously had little access or exposure to smoking treatment (Piper et al, 2010) and thus saw the additional support provided by treatment as affording them an especially good opportunity to try quitting. The finding that underserved smokers were especially likely to make quit attempts supports the notion that Motivation-phase treatment might be especially helpful for smokers who might not otherwise enter cessation treatment or benefit from it (Petersen et al, 2017).…”

“…Growing evidence suggests that reduction treatment expands the reach of tobacco treatment by engaging smokers who might not otherwise enter cessation treatment (Petersen et al, 2017). Reduction treatment has also been shown to decrease smoking heaviness and increase abstinence (Ali et al, 2018;Cook et al, 2016;Moore et al, 2009).…”

“…Quit attempts are an important treatment target since they represent an increase in motivational activation necessary for change (Baker et al, 2011;Prochaska and DiClemente, 1983). While it is true that most quit attempts ultimately fail (Babb et al, 2017), they may spur later quit attempts and result in learning that makes these later attempts more successful (Petersen et al, 2017). This research is aimed at not only identifying Motivation-phase intervention components that increase quit attempts, but also evaluating the clinical significance of the resulting attempts: i.e., their association with abstinence.…”