Identifying Optimal Smoking Cessation Intervention Components for Smoking Cessation

Introduction: It is vital to enhance the progress of smoking cessation treatment research. Using the Multiphase Optimization Strategy (MOST) we have attempted to identify effective smoking cessation intervention components that can be combined in an evidence-based manner to produce an optimized treatment package that significantly improves cessation outcomes. We selected potential intervention components using the Phase-Based Model of Cessation, which identifies challenges and opportunities at each phase of cessation, from preparing to quit, to making the actual quit attempt, to maintaining abstinence.

Methods: Smokers willing to quit were recruited from 11 primary care clinics in Wisconsin and were randomly assigned to one of two MOST cessation trials. Study 1 (N=637) used a fractional factorial design to assess 6 interventions that focused on the Preparation and Cessation Phases: 1) Pre-quit Nicotine Patch vs. No Nicotine Patch, 2) Pre-quit Nicotine Gum vs. No Nicotine Gum, 3) Pre-quit Counseling vs. None, 4) 16 vs. 8 Weeks of Nicotine Patch + Nicotine Gum, 5) Intensive In-person Counseling vs. Minimal, and 6) Intensive Phone Counseling vs. Minimal. Study 2 (N=545) used a full factorial design to assess 5 intervention components that focused on the Maintenance Phase and medication adherence: 1) 26 vs. 8 Weeks of Nicotine Patch + Nicotine Gum, 2) Maintenance Phone Counseling vs. None, 3) Cognitive Medication Adherence Counseling (C-MAC) vs. None, 4) Electronic Medication Monitoring Device + Adherence Feedback vs. Medication Monitoring Device Only, and 5) Automated Adherence Prompting Calls vs. None.

Results: Across these two studies we identified intervention components with significant effects on phase-specific outcomes. For instance, Intensive In-person Counseling produced significantly higher initial cessation rates (p<.05) and reduced post-quit cravings (p < .05) relative to Minimal In-person Counseling; 26 weeks of combination nicotine replacement therapy (NRT) significantly increased 26-week abstinence rates relative to 8 weeks of combination NRT (p<.05). With respect to adherence interventions, we found that Maintenance Counseling interacted with C-MAC to produce the highest nicotine patch and nicotine gum adherence rates from Weeks 3-6 (p<.05).

Conclusions: The results from these two studies are being used to develop an optimized smoking cessation treatment package that includes only effective intervention components that work well together in real-world healthcare settings. These optimized treatments will then be compared with Usual Care treatment to demonstrate real-world optimization of smoking treatment.