A self-help cessation program for smokeless tobacco users: comparison of two interventions

Area of Science:

• Public Health
• Addiction Medicine
• Behavioral Science

Background:

• Smokeless tobacco (SLT) use has increased, yet research on cessation interventions remains limited.
• Existing interventions for SLT cessation are not well-evaluated.
• There is a need for effective, scalable interventions for SLT users.

Purpose of the Study:

• To evaluate two levels of self-help cessation interventions for adult smokeless tobacco users.
• To determine the efficacy of assisted self-help versus manual-only interventions.
• To assess the impact of interventions on both SLT and all tobacco use cessation.

Main Methods:

• A large-scale randomized trial involving 1069 adult SLT users from five Northwest states.
• Participants were randomized to receive either a Manual Only (MAN) intervention or an Assisted Self-Help (ASH) intervention (manual, video, and two phone calls).
• Outcomes were assessed at 6-month follow-up using an intent-to-treat model.

Main Results:

• The Assisted Self-Help (ASH) group showed significantly higher quit rates for smokeless tobacco (23.4% vs. 18.4%) and all tobacco use (21.1% vs. 16.5%) compared to the Manual Only (MAN) group (p < 0.05).
• Adherence to recommended cessation procedures mediated the intervention's effect on outcomes.
• Phone counselor support in the ASH condition appeared to enhance the adoption of behavioral cessation strategies.

Conclusions:

• Low-cost, minimal interventions delivered via mail and phone are effective for facilitating smokeless tobacco cessation.
• The Assisted Self-Help intervention model demonstrates superior efficacy compared to a manual-only approach.
• Public health strategies should consider these scalable, cost-effective interventions for SLT users.