title: Comparative effectiveness of motivation phase intervention components for use with smokers unwilling to quit: a factorial screening experiment.
abstract: OBJECTIVE
  To screen promising intervention components designed to reduce smoking and promote abstinence in smokers initially unwilling to quit.
  
  
  METHODS
  A balanced, four-factor, randomized factorial experiment.
  
  
  METHODS
  Eleven primary care clinics in southern Wisconsin, USA.
  
  
  METHODS
  A total of 517 adult smokers (63.4% women, 91.1% white) recruited during primary care visits who were willing to reduce their smoking but not quit.
  
  
  METHODS
  Four factors contrasted intervention components designed to reduce smoking and promote abstinence: (1) nicotine patch versus none; (2) nicotine gum versus none; (3) motivational interviewing (MI) versus none; and (4) behavioral reduction counseling (BR) versus none. Participants could request cessation treatment at any point during the study.
  
  
  METHODS
  The primary outcome was percentage change in cigarettes smoked per day at 26 weeks post-study enrollment; the secondary outcomes were percentage change at 12 weeks and point-prevalence abstinence at 12 and 26 weeks post-study enrollment.
  
  
  RESULTS
  There were few main effects, but a significant four-way interaction at 26 weeks post-study enrollment (P = 0.01, β = 0.12) revealed relatively large smoking reductions by two component combinations: nicotine gum combined with BR and BR combined with MI. Further, BR improved 12-week abstinence rates (P = 0.04), and nicotine gum, when used without MI, increased 26-week abstinence after a subsequent aided quit attempt (P = 0.01).
  
  
  CONCLUSIONS
  Motivation-phase nicotine gum and behavioral reduction counseling are promising intervention components for smokers who are initially unwilling to quit.
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, Madison, WI, USA.|University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI, USA.|William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
authors.forename: Jessica W
authors.initials: JW
authors.lastname: Cook
authors.affiliation: The Pennsylvania State University, The Methodology Center and Department of Human Development and Family Studies, University Park, PA, USA.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Collins
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, Madison, WI, USA.|University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Fiore
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, Madison, WI, USA.|University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI, USA.
authors.forename: Stevens S
authors.initials: SS
authors.lastname: Smith
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, Madison, WI, USA.|University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI, USA.
authors.forename: David
authors.initials: D
authors.lastname: Fraser
authors.affiliation: University of Wisconsin, Department of Educational Psychology, Madison, WI, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Bolt
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, Madison, WI, USA.|University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI, USA.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Baker
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, Madison, WI, USA.|University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI, USA.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Piper
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, Madison, WI, USA.|University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI, USA.
authors.forename: Tanya R
authors.initials: TR
authors.lastname: Schlam
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, Madison, WI, USA.|University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Jorenby
authors.affiliation: University of Wisconsin, Department of Statistics, Madison, WI, USA.
authors.forename: Wei-Yin
authors.initials: WY
authors.lastname: Loh
authors.affiliation: University of Illinois at Chicago, Institute for Health Research and Policy, Chicago, IL, USA.
authors.forename: Robin
authors.initials: R
authors.lastname: Mermelstein
mesh_terms: D057186:Comparative Effectiveness Research / Q000379:methods*; D003376:Counseling; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D062405:Motivational Interviewing; D018722:Nicotinic Agonists / Q000627:therapeutic use*; D016540:Smoking Cessation / Q000379:methods*; D061485:Tobacco Use Cessation Devices / Q000706:statistics & numerical data*; D014029:Tobacco Use Disorder / Q000628:therapy*; D016896:Treatment Outcome; D014922:Wisconsin
chemical_list: D018722:Nicotinic Agonists
keywords: Chronic care smoking treatment; Multi-phase Optimization Strategy (MOST); Phase-Based Model; comparative effectiveness; factorial experiment; motivational interviewing; nicotine replacement therapy; primary care; smoking cessation; smoking reduction