Toward precision smoking cessation treatment II: Proximal effects of smoking cessation intervention components on putative mechanisms of action

Abstract

Background Understanding how smoking cessation treatments exert their effects can inform treatment development and use. Factorial designs allow researchers to examine whether multiple intervention components affect hypothesized change mechanisms, and whether the affected mechanisms are related to cessation. Methods This is a secondary data analysis of smokers recruited during primary care visits (N=637, 55% women, 87% white) who were motivated to quit. Participants in this fractional factorial experiment were randomized to one level of each of six intervention factors: Prequit Nicotine Patch vs None, Prequit Nicotine Gum vs None, Preparation Counseling vs None, Intensive In-Person Counseling vs Minimal, Intensive Phone Counseling vs Minimal, and 16 vs 8 Weeks of Combination Nicotine Replacement (nicotine patch+nicotine gum). Data on putative mechanisms (e.g., medication use, withdrawal, self-efficacy) and smoking status were gathered using daily assessments and during follow-up assessment calls. Results Some intervention components influenced hypothesized mechanisms. Prequit Gum and Patch each reduced prequit smoking and enhanced prequit coping and self-efficacy. In-Person Counseling increased prequit motivation to quit, postquit self-efficacy, and postquit perceived intratreatment support. Withdrawal reduction and reduced prequit smoking produced the strongest effects on cessation. The significant effect of combining Prequit Gum and In-Person Counseling on 26-week abstinence was mediated by increased prequit self-efficacy. Conclusions This factorial experiment identified which putative treatment mechanisms were influenced by discrete intervention components and which mechanisms influenced cessation. Such information supports the combined use of prequit nicotine gum and intensive in-person counseling as cessation interventions that operate via increased prequit self-efficacy.

Indicators of cigarette smoking dependence and relapse in former smokers who vape compared with those who do not: findings from the 2016 International Tobacco Control Four Country Smoking and Vaping Survey

“…This is possibly because vaping is mimicking aspects of smoking, including positive aspects, in a way that NRT does not . There is little research on self‐efficacy and NRT use post‐quitting, although one study found no significant increase in self‐efficacy with NRT use after the quit attempt . The most recent Cochrane review for relapse prevention found some evidence for extended use of varenicline but not for NRT, although NRT appeared to be useful for those who had quit without support.…”

Understanding contexts of smoking and vaping among dual users: analysis of ecological momentary assessment data

“…being around others smoking or vaping) and internal cues (positive and negative affect, craving, difficulty concentrating). We have used the internal cue items in previous EMA research [31–33]; many items were adapted from established measures, including the positive and negative affect schedule (PANAS) and the Wisconsin smoking withdrawal scale (WSWS) [34,35]. Expectations of reward from product use were also assessed.…”

The 2016 Ferno Award Address: Three Things

“…This disjunction between what counseling treatment affects, and what affects abstinence, warrants attention; we essentially replicated this disconnect in a second, more recent study. 16 It is worth considering how different the results have been for research on the mediation of pharmacotherapy effects. Studies have consistently shown that pharmacotherapies reliably and meaningfully reduce major determinants of cessation success: that is, craving and withdrawal symptoms.…”