title: Front-loaded versus weekly counseling for treatment of tobacco addiction.
abstract: BACKGROUND
  Approximately 60%-70% of cigarette smokers who try to quit relapse by 2 weeks postcessation. We tested the efficacy of a front-loaded (FL) counseling intervention whose goal was to increase the likelihood of successful early abstinence and subsequent long-term abstinence.
  
  
  METHODS
  We randomized 278 adult smokers to an FL or weekly behavioral smoking cessation counseling schedule. The total number of sessions across treatment was the same for both groups. However, those assigned to the FL schedule received 6 counseling sessions in the first 2 weeks postcessation, while those in the weekly condition received 2 sessions. Participants in both groups also received standard nicotine patch treatment.
  
  
  RESULTS
  At 1 year postcessation, FL participants were significantly less likely to have relapsed when continuous abstinence was used as the definition of abstinence/relapse (11.7% abstinent vs. 6.3%, hazard ratio [HR] = 0.69, p = .007); and there were nonsignificant trends for FL subjects to have better outcomes when abstinence was defined as never smoking for 7 or more consecutive days nor for 7 or more consecutive episodes (18.4% abstinent vs. 14.8%, HR = 0.83, p = .20) and as point prevalence abstinence (15.6% abstinent vs. 12.9%, p = .11). The relationship between FL counseling treatment and continuous abstinence was partially mediated by higher postcessation levels of social support perceived from counseling and greater use of cessation-related coping strategies.
  
  
  CONCLUSIONS
  We conclude that FL counseling is a promising treatment model that should be evaluated further, perhaps using modifications of the FL schedule used in this study.
authors: Harvard School of Dental Medicine, Boston, MA, USA. arthur_garvey@hms.harvard.edu
authors: Arthur J
authors: AJ
authors: Garvey
authors: David
authors: D
authors: Kalman
authors: Randall A
authors: RA
authors: Hoskinson
authors: Taru
authors: T
authors: Kinnunen
authors: Brianna M
authors: BM
authors: Wadler
authors: Carey C
authors: CC
authors: Thomson
authors: Bernard
authors: B
authors: Rosner
mesh_terms: D000328:Adult; D000368:Aged; D003376:Counseling; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014029:Tobacco Use Disorder / Q000628:therapy*