A multi-level analysis of non-significant counseling effects in a randomized smoking cessation trial
Article first published online: 15 SEP 2010
© 2010 The Authors, Addiction © 2010 Society for the Study of Addiction
Volume 105, Issue 12, pages 2195–2208, December 2010
How to Cite
McCarthy, D. E., Piasecki, T. M., Jorenby, D. E., Lawrence, D. L., Shiffman, S. and Baker, T. B. (2010), A multi-level analysis of non-significant counseling effects in a randomized smoking cessation trial. Addiction, 105: 2195–2208. doi: 10.1111/j.1360-0443.2010.03089.x
- Issue published online: 3 NOV 2010
- Article first published online: 15 SEP 2010
- Submitted 20 October 2009; initial review completed 28 January 2010; final version accepted 20 May 2010
- brief counseling;
- mechanisms of change;
- randomized clinical trial;
- smoking cessation;
- tobacco dependence
Aims To determine, in the context of a trial in which counseling did not improve smoking cessation outcomes, whether this was due to a failure of the conceptual theory identifying treatment targets or the action theory specifying interventions.
Design Data from a randomized clinical trial of smoking cessation counseling and bupropion SR were submitted to multi-level modeling to test whether counseling influenced real-time reports of cognitions, emotions and behaviors, and whether these targets predicted abstinence.
Setting Center for Tobacco Research and Intervention, Madison, WI.
Participants A total of 403 adult, daily smokers without contraindications to bupropion SR use. Participants were assigned randomly to receive individual counseling or no counseling and a 9-week course of bupropion SR or placebo pill. Cessation counseling was delivered in eight 10-minute sessions focused on bolstering social support, motivation, problem-solving and coping skills.
Measurements Pre- and post-quit ecological momentary assessments of smoking behavior, smoking triggers, active prevention and coping strategies, motivation to quit, difficulty quitting and reactions to initial lapses.
Findings Counseling prompted avoidance of access to cigarettes, improved quitting self-efficacy, reduced perceived difficulty of quitting over time and protected against guilt and demoralization following lapses. Results also supported the importance of limiting cigarette access, receiving social support, strong motivation and confidence and easing withdrawal distress during cessation efforts. Quitting self-efficacy and perceived difficulty quitting may partially mediate counseling effects on abstinence.
Conclusions Smoking cessation counseling may work by supporting confidence about quitting and reducing perceived difficulty quitting. Counseling did not affect other targets that protect against relapse.