title: Toward precision smoking cessation treatment II: Proximal effects of smoking cessation intervention components on putative mechanisms of action.
abstract: Understanding how smoking cessation treatments exert their effects can inform treatment development and use. Factorial designs allow researchers to examine whether multiple intervention components affect hypothesized change mechanisms, and whether the affected mechanisms are related to cessation.
  
  
  
  This is a secondary data analysis of smokers recruited during primary care visits (N=637, 55% women, 87% white) who were motivated to quit. Participants in this fractional factorial experiment were randomized to one level of each of six intervention factors: Prequit Nicotine Patch vs None, Prequit Nicotine Gum vs None, Preparation Counseling vs None, Intensive In-Person Counseling vs Minimal, Intensive Phone Counseling vs Minimal, and 16 vs 8 Weeks of Combination Nicotine Replacement (nicotine patch+nicotine gum). Data on putative mechanisms (e.g., medication use, withdrawal, self-efficacy) and smoking status were gathered using daily assessments and during follow-up assessment calls.
  
  
  
  Some intervention components influenced hypothesized mechanisms. Prequit Gum and Patch each reduced prequit smoking and enhanced prequit coping and self-efficacy. In-Person Counseling increased prequit motivation to quit, postquit self-efficacy, and postquit perceived intratreatment support. Withdrawal reduction and reduced prequit smoking produced the strongest effects on cessation. The significant effect of combining Prequit Gum and In-Person Counseling on 26-week abstinence was mediated by increased prequit self-efficacy.
  
  
  
  This factorial experiment identified which putative treatment mechanisms were influenced by discrete intervention components and which mechanisms influenced cessation. Such information supports the combined use of prequit nicotine gum and intensive in-person counseling as cessation interventions that operate via increased prequit self-efficacy.
authors.affiliation: Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, United States; University of Wisconsin School of Medicine and Public Health, Department of Medicine, Division of General Internal Medicine, United States. Electronic address: mep@ctri.wisc.edu.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Piper
authors.affiliation: Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, United States; University of Wisconsin School of Medicine and Public Health, Department of Medicine, Division of General Internal Medicine, United States; William S. Middleton Memorial Veterans Hospital, United States.
authors.forename: Jessica W
authors.initials: JW
authors.lastname: Cook
authors.affiliation: Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, United States; University of Wisconsin School of Medicine and Public Health, Department of Medicine, Division of General Internal Medicine, United States.
authors.forename: Tanya R
authors.initials: TR
authors.lastname: Schlam
authors.affiliation: Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, United States; University of Wisconsin School of Medicine and Public Health, Department of Medicine, Division of General Internal Medicine, United States.
authors.forename: Stevens S
authors.initials: SS
authors.lastname: Smith
authors.affiliation: University of Wisconsin, Department of Educational Psychology, United States.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Bolt
authors.affiliation: The Methodology Center and Department of Human Development and Family Studies, The Pennsylvania State University, United States.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Collins
authors.affiliation: University of Illinois at Chicago, Institute for Health Research and Policy, United States.
authors.forename: Robin
authors.initials: R
authors.lastname: Mermelstein
authors.affiliation: Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, United States; University of Wisconsin School of Medicine and Public Health, Department of Medicine, Division of General Internal Medicine, United States.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Fiore
authors.affiliation: Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, United States; University of Wisconsin School of Medicine and Public Health, Department of Medicine, Division of General Internal Medicine, United States.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Baker
mesh_terms: D000328:Adult; D003376:Counseling / Q000379:methods* / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009538:Nicotine / Q000008:administration & dosage; D057285:Precision Medicine / Q000379:methods* / Q000639:trends; D020377:Self Efficacy; D012907:Smoking / Q000523:psychology* / Q000628:therapy* / Q000639:trends; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology*; D061485:Tobacco Use Cessation Devices; D016896:Treatment Outcome
chemical_list: D009538:Nicotine
keywords: Factorial design; Mechanisms; Smoking cessation; Treatment