4.6 Article

Comparative effectiveness of intervention components for producing long-term abstinence from smoking: a factorial screening experiment

Journal

ADDICTION
Volume 111, Issue 1, Pages 142-155

Publisher

WILEY
DOI: 10.1111/add.13153

Keywords

Chronic care smoking treatment; comparative effectiveness; electronic medication monitoring; factorial experiment; medication adherence; Multiphase Optimization Strategy (MOST); nicotine replacement therapy; Phase-Based Model of smoking treatment; primary care; relapse prevention; smoking cessation; tobacco dependence

Funding

  1. National Cancer Institute [9P50CA143188, 1K05CA139871]
  2. Wisconsin Partnership Program
  3. National Research Service Award from the Health Resources and Services Administration [T32HP10010]
  4. National Science Foundation [DMS-1305725]
  5. NIH [P50DA10075, R01DK097364]
  6. Merit Review Award from the US Department of Veterans Affairs [101CX00056]
  7. Eli Lilly and Company
  8. Direct For Mathematical & Physical Scien
  9. Division Of Mathematical Sciences [1305725] Funding Source: National Science Foundation

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AimsTo identify promising intervention components that help smokers attain and maintain abstinence during a quit attempt. DesignA 2x2x2x2x2 randomized factorial experiment. SettingEleven primary care clinics in Wisconsin, USA. ParticipantsA total of 544 smokers (59% women, 86% white) recruited during primary care visits and motivated to quit. InterventionsFive intervention components designed to help smokers attain and maintain abstinence: (1) extended medication (26 versus 8 weeks of nicotine patch+nicotine gum); (2) maintenance (phone) counseling versus none; (3) medication adherence counseling versus none; (4) automated (medication) adherence calls versus none; and (5) electronic medication monitoring with feedback and counseling versus electronic medication monitoring alone. MeasurementsThe primary outcome was 7-day self-reported point-prevalence abstinence 1 year after the target quit day. FindingsOnly extended medication produced a main effect. Twenty-six versus 8 weeks of medication improved point-prevalence abstinence rates (43 versus 34% at 6 months; 34 versus 27% at 1 year; P =0.01 for both). There were four interaction effects at 1 year, showing that an intervention component's effectiveness depended upon the components with which it was combined. ConclusionsTwenty-six weeks of nicotine patch+nicotine gum (versus 8 weeks) and maintenance counseling provided by phone are promising intervention components for the cessation and maintenance phases of smoking treatment.

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