Treating those not ready to quit smoking: Doing harm while trying to help?

Area of Science:

• Addiction Medicine
• Behavioral Psychology
• Public Health

Background:

• Motivation-phase smoking treatment aims to increase engagement and abstinence in unmotivated smokers.
• Current motivation-phase interventions, including nicotine replacement therapy (NRT) and reduction counseling, show modest and inconsistent effectiveness.
• Identifying factors influencing intervention efficacy is crucial for optimizing smoking cessation strategies.

Purpose of the Study:

• To identify demographic and smoking-related factors predicting differential treatment response in motivation-phase smoking cessation.
• To explore the influence of quitting self-efficacy on the effectiveness of NRT and reduction counseling.

Main Methods:

• Secondary analysis of a randomized trial involving 577 primary care patients unwilling to quit smoking.
• Participants received smoking reduction counseling, nicotine mini-lozenge, behavioral activation, or 5Rs-motivational counseling.
• Machine learning was used to analyze predictors of quit attempts, cessation treatment entry, and 1-year abstinence.

Main Results:

• Higher quitting self-efficacy predicted increased likelihood of quit attempts and cessation treatment entry.
• Smokers with low self-efficacy (≤3.5/5) showed reduced odds of quit attempts with reduction counseling (OR=0.51) and reduced odds of cessation treatment entry with nicotine mini-lozenge (OR=0.55).
• No significant intervention effects were observed for smoking abstinence at one year.

Conclusions:

• Baseline quitting self-efficacy may identify individuals unlikely to benefit from standard motivation-phase smoking cessation treatments.
• A precision medicine approach is needed, suggesting tailored therapeutic strategies for individuals with low self-efficacy.
• Further research is warranted to determine optimal treatment approaches for individuals declining cessation interventions.