(Hughes, John R., P.I.)
A Test of Two Clinical Treatments for Ambivalent Smokers Despite tobacco control interventions, the incidence of quitting among US smokers has not increased in the last decade. One way to increase quitting is to increase quit attempts and the most common clinical methods to do so are brief advice to quit and provision of information about treatments. Newer clinical methods to prompt quit attempts that have empirical support are smoking reduction and motivational counseling. In a prior randomized controlled trial (RCT), we found that three brief phone calls advising reduction in cigs/day aided by nicotine replacement therapy (NRT), or the USPHS 5 R’s motivational intervention, both increased quit attempts (ORs = 4.2 and 5.6) and point-prevalent abstinence (ORs = 4.5 and 6.3) compared to no treatment. We now propose a conceptual replication and extension test of these results for several reasons: 1) many smokers are reluctant to use NRT, thus we wish to see if reduction unaided by NRT can be effective, 2) our prior study is the only test of the widely-cited USPHS 5 R’s intervention and obtained a much larger effect size than prior motivational interventions (OR = 1.3-1.5); thus, we believe a replication important, and 3) we wished to increase methodological rigor by employing a usual care (rather than a no treatment) control group. Our methods will be similar to our prior trial. We will proactively contact adult, daily smokers to recruit 850 smokers who wish to quit at some point but have no plans to quit in the next month. We will randomize them to a) reduction counseling without the aid of NRT, b) counseling guided by the USPHS 5 R’s, or c) usual care. The first two conditions will be delivered via brief counseling calls at study onset and then 2 and 4 weeks later (total = 35 min). The usual care condition will consist of three newsletters advising smoker to quit and providing information on quitting sent at these same times. Our major hypothesis is that the incidence of quit attempts over the 6 months of the study will be greater in both the 5 Rs and the reduction conditions than in the usual care condition. A secondary hypothesis is that the increase in quit attempts will lead to increased abstinence. Another secondary hypothesis is that beneficial effects of both treatments will be mediated by increases in self-efficacy and intentions to quit. We hypothesize that decreases in cigs/day and nicotine dependence will mediate the efficacy of the reduction treatment but not the 5 Rs treatment and, conversely, we hypothesize that a shift in decisional balance will mediate the efficacy of the 5 Rs treatment but not of the reduction treatment. The significance of our proposal is described in the narrative.