Abstract
Socioeconomic disparities in treatment failure rates for evidence-based tobacco dependence treatment are well-established. Adapted cognitive behavioral treatments are extensively tailored to meet the needs of lower socioeconomic status (SES) smokers and dramatically improve early treatment success, but there is little understanding of why treatment failure occurs after a longer period of abstinence than with standard treatment, why early treatment success is not sustained, and why long-term treatment failure rates are no different from standard treatments. We sought to understand the causes of treatment failure from the perspective of diverse participants who relapsed after receiving standard or adapted treatment in a randomized control trial. We used a qualitative approach and a cognitive-behavioral framework to examine themes in responses to a semi-structured post-relapse telephone interview. The primary causes of relapse were familiar (i.e., habit, stress, unanticipated precipitating events). The adapted treatment appeared to improve the management of habits and stress short-term, but did not adequately prepare respondents for unanticipated events. Respondents reported that they would have benefited from continued support. New therapeutic targets might include innovative methods to reduce long-term treatment failure by delivering extended relapse prevention interventions to support early treatment success.Trial Registration: Clinicaltrials.gov NCT02785536.
Highlights
Cigarette smoking is a leading contributor to socioeconomic health disparities (Mokdad et al, 2004; Jha et al, 2006; American Cancer Society, 2016)
While evidence-based multicomponent cognitive-behavioral treatment (CBT) for tobacco dependence is effective for all smokers, there are well-established socioeconomic and racial disparities in treatment outcomes assessed in terms of treatment success and treatment failure (Judge et al, 2005; Robles et al, 2008; Hiscock et al, 2012; Sheffer et al, 2013; Varghese et al, 2014)
We provided the dates of first relapse in the randomized control trials (RCTs) and asked about events occurring in their lives at that time, their overall mood, and details about the day they started smoking again such as where they were, time of day, who was with them, and how they obtained cigarettes
Summary
Cigarette smoking is a leading contributor to socioeconomic health disparities (Mokdad et al, 2004; Jha et al, 2006; American Cancer Society, 2016). While evidence-based multicomponent cognitive-behavioral treatment (CBT) for tobacco dependence is effective for all smokers, there are well-established socioeconomic and racial disparities in treatment outcomes assessed in terms of treatment success (e.g., abstinence or quit rates) and treatment failure (e.g., relapse rates) (Judge et al, 2005; Robles et al, 2008; Hiscock et al, 2012; Sheffer et al, 2013; Varghese et al, 2014). Socioeconomic and racial disparities in treatment failure rates are found for most evidence-based tobacco dependence treatments (Fiore et al, 2008; Robles et al, 2008; Hiscock et al, 2012; Nollen et al, 2017)
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