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

Abstract

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. A parallel-group randomized controlled trial of brief motivational (n=185), reduction (n=186) or usual care (n=189) telephone interventions delivered over the course of 4weeks. Outcomes were assessed at 6- and 12-month follow-ups. No medication was provided. United States. A total of 560 adult smokers of ≥10 cigarettes per day who were not ready to quit in the next 30days. The primary outcomes were whether participants made a QA that lasted ≥24hours 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. A priori-defined comparisons were between motivational versus usual care and reduction versus usual care conditions. The probability of making a QA that lasted ≥24hours 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)=0.78-1.82; reduction versus usual care OR=0.89, 95% CI=0.57-1.36]. Bayes factors ranged from 0.13 to 0.18. Findings regarding a QA of any length were similar. At 6months, the motivational condition had marginally more abstinence than usual care (11 versus 5%, OR=2.17, 95% CI=0.99-4.77), but the reduction condition was not significantly different from usual care (8 versus 5%, OR=1.57, 95% CI=0.69-3.59). At 12months, the motivational condition had significantly more abstinence than usual care (10 versus 4%, OR=2.80, 95% CI=1.14-6.88) and the reduction condition had marginally more abstinence than usual care (9 versus 4%, OR=2.45, 95% CI=0.98-6.09). 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 6months. The motivational intervention appeared to increase abstinence at 6months and did increase abstinence at 12months. The reduction intervention did not increase abstinence at 6months but appeared to increase abstinence at 12months.