Motivational, reduction and usual care interventions for smokers who are not ready to quit: a randomized controlled trial : Motivational and reduction interventions

Abstract

<div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d346626e164">Aims</h5> <p id="P1">To test whether, in comparison to usual care, brief motivational or reduction interventions increase quit attempts (QA) or abstinence among smokers who are not ready to quit. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d346626e169">Design</h5> <p id="P2">A parallel-group randomized controlled trial of brief motivational ( <i>n</i>=185), reduction ( <i>n</i>=186), or usual care ( <i>n</i>=189) telephone interventions delivered over the course of 4 weeks. Outcomes were assessed at 6- and 12-month follow-ups. No medication was provided. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d346626e183">Setting</h5> <p id="P3">United States.</p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d346626e188">Participants</h5> <p id="P4">560 adult smokers of ≥ 10 cigarettes per day who were not ready to quit in the next 30 days. </p> </div><div class="section"> <a class="named-anchor" id="S5"> <!-- named anchor --> </a> <h5 class="section-title" id="d346626e193">Measurements</h5> <p id="P5">The primary outcomes were whether participants made a QA that lasted ≥ 24 hours and whether they made a QA of any length between baseline and 6-months. Secondary outcomes included 7-day point-prevalence abstinence at 6- and 12-months. The 12-month follow-up was added after the study began. </p> </div><div class="section"> <a class="named-anchor" id="S6"> <!-- named anchor --> </a> <h5 class="section-title" id="d346626e198">Findings</h5> <p id="P6">A-priori defined comparisons were between motivational versus usual care and reduction versus usual care conditions. The probability of making a QA that lasted ≥ 24 hours was not significantly different between the motivational (38%) or the reduction (31%) conditions and the usual care (34%) condition (motivational versus usual care odds ratio (OR)=1.19 95% confidence interval (CI)=0.78 to 1.82; reduction versus usual care OR=0.89 95% CI=0.57 to 1.36). Bayes factors ranged from 0.13 to 0.18. Findings regarding a QA of any length were similar. At 6 months, the motivational condition had marginally more abstinence than usual care (11% versus 5% OR=2.17 95% CI=0.99 to 4.77) but the reduction condition was not significantly different from usual care (8% versus 5% OR=1.57 95% CI=0.69 to 3.59). At 12 months, the motivational condition had significantly more abstinence than usual care (10% versus 4% OR=2.80 95% CI=1.14 to 6.88) and the reduction condition had marginally more abstinence than usual care (9% versus 4% OR=2.45 95% CI=0.98 to 6.09). </p> </div><div class="section"> <a class="named-anchor" id="S7"> <!-- named anchor --> </a> <h5 class="section-title" id="d346626e203">Conclusions</h5> <p id="P7">Among adult smokers who are not ready to quit, both logistic regression and Bayesian analysis indicate that neither motivational nor reduction-based telephone interventions increased the odds of making a quit attempt in comparison to usual care at 6 months. The motivational intervention appeared to increase abstinence at 6 months and did increase abstinence at 12 months. The reduction intervention did not increase abstinence at 6 months but appeared to increase abstinence at 12 months. </p> </div>