title: A Randomized Trial of Motivational Interviewing: Cessation Induction Among Smokers With Low Desire to Quit.
abstract: BACKGROUND
  Despite limitations in evidence, the current Clinical Practice Guideline advocates Motivational Interviewing for smokers not ready to quit. This study evaluated the efficacy of Motivational Interviewing for inducing cessation-related behaviors among smokers with low motivation to quit.
  
  
  METHODS
  Randomized clinical trial.
  
  
  METHODS
  Two-hundred fifty-five daily smokers reporting low desire to quit smoking were recruited from an urban community during 2010-2011 and randomly assigned to Motivational Interviewing, health education, or brief advice using a 2:2:1 allocation. Data were analyzed from 2012 to 2014.
  
  
  METHODS
  Four sessions of Motivational Interviewing utilized a patient-centered communication style that explored patients' own reasons for change. Four sessions of health education provided education related to smoking cessation while excluding elements characteristic of Motivational Interviewing. A single session of brief advice consisted of brief, personalized advice to quit.
  
  
  METHODS
  Self-reported quit attempts; smoking abstinence (biochemically verified); use of cessation pharmacotherapies; motivation; and confidence to quit were assessed at baseline and 3- and 6-month follow-ups.
  
  
  RESULTS
  Unexpectedly, no significant differences emerged between groups in the proportion who made a quit attempt by 6-month follow-up (Motivational Interviewing, 52.0%; health education, 60.8%; brief advice, 45.1%; p=0.157). Health education had significantly higher biochemically verified abstinence rates at 6 months (7.8%) than brief advice (0.0%) (8% risk difference, 95% CI=3%, 13%, p=0.003), with the Motivational Interviewing group falling in between (2.9% abstinent, 3% risk difference, 95% CI=0%, 6%, p=0.079). Both Motivational Interviewing and health education groups showed greater increases in cessation medication use, motivation, and confidence to quit relative to brief advice (all p<0.05), and health education showed greater increases in motivation relative to Motivational Interviewing (Cohen's d=0.36, 95% CI=0.12, 0.60).
  
  
  CONCLUSIONS
  Although Motivational Interviewing was generally more efficacious than brief advice in inducing cessation behaviors, health education appeared the most efficacious. These results highlight the need to identify the contexts in which Motivational Interviewing may be most efficacious and question recommendations to use Motivational Interviewing rather than other less complex cessation induction interventions.
  
  
  BACKGROUND
  This study is registered at www.clinicaltrials.gov NCT01188018.
authors.affiliation: Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri. Electronic address: catleyd@umkc.edu.
authors.forename: Delwyn
authors.initials: D
authors.lastname: Catley
authors.affiliation: Division of Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri; Schools of Medicine and Pharmacy, University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: Kathy
authors.initials: K
authors.lastname: Goggin
authors.affiliation: School of Public and Community Health Sciences, The University of Montana, Missoula, Montana.
authors.forename: Kari Jo
authors.initials: KJ
authors.lastname: Harris
authors.affiliation: Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Missouri.
authors.forename: Kimber P
authors.initials: KP
authors.lastname: Richter
authors.affiliation: Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
authors.forename: Karen
authors.initials: K
authors.lastname: Williams
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Christi
authors.initials: C
authors.lastname: Patten
authors.affiliation: Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan.
authors.forename: Ken
authors.initials: K
authors.lastname: Resnicow
authors.affiliation: Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Missouri.
authors.forename: Edward F
authors.initials: EF
authors.lastname: Ellerbeck
authors.affiliation: Division of Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bradley-Ewing
authors.affiliation: School of Interdisciplinary Arts and Sciences, University of Washington Tacoma, Tacoma, Washington.
authors.forename: Hyoung S
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: Jose L
authors.initials: JL
authors.lastname: Moreno
authors.affiliation: Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: James E
authors.initials: JE
authors.lastname: Grobe
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D062405:Motivational Interviewing / Q000379:methods*; D012907:Smoking / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D000074606:Smoking Prevention; D013997:Time Factors; D061485:Tobacco Use Cessation Devices; D014505:Urban Population