Search

Much is known about the outcomes of different smoking reduction and cessation programs. However there is a lack of information about the degree to which such programs can achieve successes after initial failures. This study evaluated the patterns of success and failure during a smoking reduction intervention with a sample of 164 adult smokers (mean age 62; mean baseline smoking rate 21.2 cigarettes per day) who wanted to reduce their smoking but were not ready to attempt cessation. Success was defined by both self-reported number of cigarettes smoked assessed during counseling calls and carbon monoxide levels at 3 and 12 month follow-ups. There was a strong relationship between initial success/failure and eventual outcome using both assessment methods, and a moderate relationship between success categorization using the different methods (r=.43). Qualitative contextual data identified that types of travel, work and family environmental barriers experienced differed across success categories. This research confirms the importance of initial success in changing addictive behaviors and suggests directions for future research; including ways to enhance initial success, and the suggestion that more study is needed regarding the generalizability of these findings across settings and behaviors., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

The aim of this article is to describe the process of using theory to form strategies for a generalizable smoking reduction intervention delivered through multiple intervention modalities. This report describes the process of integrating theory, data from diverse sources, staff from three different organizations, and different intervention modalities into an efficient, large-scale smoking reduction program featuring automated data from electronic medical records, computer-assisted telephone interviews, and tailored newsletters. The authors successfully developed a program that was consistently implemented as planned for 320 smokers in a managed care organization. The mapping of theory to intervention, data transfer and security procedures, and processes and strategies used to overcome challenges to intervention implementation should provide lessons learned for similar health promotion projects. Few intervention studies discuss details of how they translate theory into practice or how they integrate different modalities and collaborating institutions, but such integration is critical for project success.

Background/purpose: Cost and cost effectiveness of behavioral interventions are critical parts of dissemination and implementation into non-academic settings. Due to the lack of indicative data and policy makers' increasing demands for both program effectiveness and efficiency, cost analyses can serve as valuable tools in the evaluation process., Methods: To stimulate and promote broader use of practical techniques that can be used to efficiently estimate the implementation costs of behavioral interventions, we propose a set of analytic steps that can be employed across a broad range of interventions., Results/conclusions: Intervention costs must be distinguished from research, development, and recruitment costs. The inclusion of sensitivity analyses is recommended to understand the implications of implementation of the intervention into different settings using different intervention resources. To illustrate these procedures, we use data from a smoking reduction practical clinical trial to describe the techniques and methods used to estimate and evaluate the costs associated with the intervention. Estimated intervention costs per participant were $419, with a range of $276 to $703, depending on the number of participants.

Introduction: There have been few comprehensive evaluations of smoking reduction, especially in health care delivery systems, and little is known about its cost, maintenance of reduced smoking, or robustness across patient subgroups., Methods: A generally representative sample of 320 adult smokers from an HMO scheduled for outpatient surgery or a diagnostic procedure was randomized to enhanced usual care or a theory-based smoking reduction intervention that combined telephone counseling and tailored newsletters. Outcomes included cigarettes smoked, carbon monoxide levels, and costs., Results: Both intervention and control conditions continued to improve from 3- to 12-month assessments. Between-condition differences using intent-to-treat analyses on both self-report and carbon monoxide measures were nonsignificant by the 12-month follow-up (25% vs. 19% achieved 50% or greater reductions in cigarettes smoked). The intervention was implemented consistently despite logistical constraints and was generally robust across patient characteristics (eg, education, ethnicity, health literacy, dependence)., Conclusions: In the absence of nicotine replacement therapy, the long-term effects of this smoking reduction intervention seem modest and nonsignificant. Future research is indicated to enhance intervention effects and conduct more comprehensive economic analyses of program variations.

Objective: This study evaluated the reach, initial effectiveness, and potential moderators and mediators of results of a smoking reduction program., Design: A generally representative sample of 320 adult smokers from an HMO, scheduled for outpatient surgery or a diagnostic procedure, were randomized to enhanced usual care or a theory-based smoking reduction intervention that combined telephone counseling and tailored newsletters., Main Outcome Measures: Self-reported number of cigarettes smoked and carbon monoxide levels., Results: The intervention enrolled 30% of known eligible smokers and produced reductions of 3 cigarettes per day greater than enhanced usual care. Intervention participants were significantly more likely than control participants to achieve at least a 50% reduction in self-reported number of cigarettes using complete cases, imputation analyses, and intent-to-treat procedures. Similar patterns were seen for carbon monoxide results but were significant only in complete case analyses. The intervention was generally robust across patient characteristics (e.g., education, ethnicity, health literacy, and dependence) and phone counselors., Conclusion: Initial results suggest that this program has potential to reach and assist smokers who may not participate in cessation programs. Additional research is indicated to enhance intervention effects, assess maintenance, and evaluate public health impact.

Reduction of smoking may increase the likelihood of eventual smoking cessation among those not ready to quit. We describe the development and acceptance of a smoking-reduction intervention that integrates telephone counseling sessions with newsletters. A computer-assisted telephone interviewing program generates real-time-tailored counseling delivered by lay interviewers. Pilot participants (n = 53) were adult smokers scheduled for outpatient procedures in a health maintenance organization, randomized to intervention or a control condition (quarterly mailings). Smoking levels were measured by self-report and biochemically. Among intervention participants continuing at 3 months, all but one rated their telephone support person positively on all dimensions. Counseling calls were 'about right' in number, and newsletters were perceived as quite personal. Intervention recipients reported smoking significantly fewer mean cigarettes per day at 3 months than at baseline, and significantly fewer than control participants. Comparisons were non-significant under intent-to-treat analyses and on biochemical measures. The program was well received by outpatients who were not ready to quit smoking, and was implemented successfully by telephone staff who had no previous smoking cessation counseling experience. An ongoing trial is evaluating effectiveness, cost and relationship to eventual cessation.

There is a need for innovative approaches capable of reaching smokers who would not otherwise participate in efforts to modify their smoking. This paper reports on two studies to determine whether a smoking reduction intervention would appeal to additional or different types of smokers than do cessation interventions. Study 1 attempted to contact 160 HMO smokers scheduled for outpatient surgeries. In Study 2, actual pilot reduction and cessation programs were offered to 531 smokers about to undergo out-patient surgeries or procedures. In Study 1, 39% of those eligible elected smoking reduction; and 38% selected cessation. In Study 2 of those eligible, 22% began participation in the smoking reduction program; 12% preferred a cessation approach; and 65% declined. There were few demographic or smoking history differences among those who elected smoking reduction, cessation, or declined. Among this understudied population, a sizable proportion in both studies agreed to participate in smoking reduction. If replicated, this suggests that comprehensive programs that include a smoking reduction component could substantially increase their reach.