title: Randomized trial: Quitline specialist training in gain-framed vs standard-care messages for smoking cessation.
abstract: BACKGROUND
  Smoking accounts for a large proportion of cancer-related mortality, creating a need for better smoking cessation efforts. We investigated whether gain-framed messages (ie, presenting benefits of quitting) will be a more persuasive method to encourage smoking cessation than standard-care messages (ie, presenting both costs of smoking [loss-framed] and benefits of quitting).
  
  
  METHODS
  Twenty-eight specialists working at the New York State Smokers' Quitline (a free telephone-based smoking cessation service) were randomly assigned to provide gain-framed or standard-care counseling and print materials. Smokers (n = 2032) who called the New York State Smokers' Quitline between March 10, 2008, and June 13, 2008, were exposed to either gain-framed (n = 810) or standard-care (n = 1222) messages, and all medically eligible callers received nicotine replacement therapy. A subset of 400 call recordings was coded to assess treatment fidelity. All treated smokers were contacted for 2-week and 3-month follow-up interviews. All statistical tests were two-sided.
  
  
  RESULTS
  Specialists providing gain-framed counseling used gain-framed statements statistically significantly more frequently than those providing standard-care counseling as assessed with frequency ratings for the two types of gain-framed statements, achieving benefits and avoiding negative consequences (for achieving benefits, gain-framed mean frequency rating = 3.9 vs standard-care mean frequency rating = 1.4; mean difference = -2.5; 95% confidence interval [CI] = -2.8 to -2.3; P < .001; for avoiding negative consequences, gain-framed mean frequency rating = 1.5 vs standard-card mean frequency rating = 1.0; mean difference = -0.5; 95% CI = -0.6 to -0.3; P < .001). Gain-framed counseling was associated with a statistically significantly higher rate of abstinence at the 2-week follow-up (ie, 99 [23.3%] of the 424 in the gain-framed group vs 76 [12.6%] of the 603 in the standard-care group, P < .001) but not at the 3-month follow-up (ie, 148 [28.4%] of the 522 in the gain-framed group vs 202 [26.6%] of the 760 in the standard-care group, P = .48).
  
  
  CONCLUSIONS
  Quitline specialists can be trained to provide gain-framed counseling with good fidelity. Also, gain-framed messages appear to be somewhat more persuasive than standard-care messages in promoting early success in smoking cessation.
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, 1 Long Wharf Dr, Box 18, New Haven, CT 06511, USA. benjamin.toll@yale.edu
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Toll
authors.forename: Steve
authors.initials: S
authors.lastname: Martino
authors.forename: Amy
authors.initials: A
authors.lastname: Latimer
authors.forename: Peter
authors.initials: P
authors.lastname: Salovey
authors.forename: Stephanie
authors.initials: S
authors.lastname: O'Malley
authors.forename: Shannon
authors.initials: S
authors.lastname: Carlin-Menter
authors.forename: Jessica
authors.initials: J
authors.lastname: Hopkins
authors.forename: Ran
authors.initials: R
authors.lastname: Wu
authors.forename: Paula
authors.initials: P
authors.lastname: Celestino
authors.forename: K Michael
authors.initials: KM
authors.lastname: Cummings
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D037001:Directive Counseling; D004522:Educational Status; D005260:Female; D006266:Health Education / Q000379:methods; D015277:Hotlines; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D015397:Program Evaluation; D012907:Smoking / Q000628:therapy; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology*; D013689:Telephone; D016896:Treatment Outcome; D014481:United States; D016903:Drug Monitoring