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

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Low quitting self-efficacy in smokers may indicate standard motivation-phase treatments are ineffective. Individuals with low self-efficacy may require alternative smoking cessation strategies for better outcomes.

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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.