How Understanding Change Experience In Smoking Cessation Might Inform Treatment Development

Cigarette smoking is the leading preventable cause of death and disability in the U.S., accounting for almost half a million deaths per year1,2. Despite ongoing efforts to improve cessation rates through treatment development and dissemination of evidence-based practices, less than one-third of the population use proven cessation methods and the average quit rate is 7.4%3. Qualitative research methodologies have the potential to highlight limitations and identify novel approaches or adaptations to existing behavioral treatments4 that may increase engagement, adherence, and success. Using a mixed methods approach, we examine whether smokers have insight into changes needed to quit smoking and how this insight affects actual changes made during a smoking cessation attempt as well as cessation success.

Stratified random sampling5 (Figure 1) was used to select 100 current cigarette smokers participating in an aided smoking cessation attempt as part of a larger comparative effectiveness trial. Bachelors level Health Counselors completed brief individual qualitative interviews at baseline and two-week post-quit visits. Interviews were audio-recorded and transcribed, then entered into a MS-excel file for coding purposes. Rapid data analytic methods 6,7 are being used to examine three separate domains: planned changes, used changes, and consistency in changes.

Initial themes for planned changes prior to quitting include: changing routines (no plan), change alcohol consumption, limiting smoking urges, focus on benefits of quitting, reduce exposure to social smoking cues, identify other coping mechanisms for stress, get support from friends/loved ones, make other health changes, reduce stress (no plan), get partner to quit, identify problem (no plan), planned changes unknown. Initial used changes themes include: reduce exposure to non-social paraphernalia/smoking cues, distraction/keep busy, make other health changes, changed daily routine, change mindset, reduce exposure to social smoking cues, get support from friends/loved ones. Consistency between planned and used changes revealed participants use both planned and unplanned changes, while some reported not knowing what to do prior to quitting and others identified additional changes needed.

Ongoing rapid content analysis6 revealed multiple themes for smoker-identified planned and used changes to improve cessation success, but analyses need to be completed. We will then examine distribution of themes based on race, gender, psychiatric history, and nicotine dependence as well as the ability of smokers to identify and make changes. Exploratory analyses will descriptively examine differences between smokers who did and did not identify changes on cessation success. Findings will guide treatment development and adaptations for behavioral smoking cessation treatments.