Shaping Reduced Smoking in Smokers Without Cessation Plans (original) (raw)
Related papers
Shaping smoking cessation using percentile schedules
Drug and Alcohol Dependence, 2004
Behavioral interventions that provide incentives contingent upon abstinence are effective addiction treatments. Nevertheless, these treatments often fail for individuals whose recent behaviors are very different from those reinforced. These hard-to-treat individuals may require shaping to achieve abstinence. We used percentile schedules to shape smokers' delivery of breath samples indicative of recent smoking abstinence (breath carbon monoxide (BCO) <4 ppm). Percentile schedules deliver incentives to current behaviors proximal to the target. Participants (N = 102) were assigned to treatments delivering incentives for breath COs at or below the 10th, 30th, 50th, or 70th percentile of recent breath COs. Each condition effectively ensured contact with available contingencies, and resulted in BCO <4 ppm in >90% of the 30th, 50th and 70th percentile groups versus 63% in the 10th percentile. The 30th, 50th and 70th percentiles were especially effective in a sub-sample of hard-to-treat participants who did not deliver a breath CO <4 ppm during an initial abstinence test or during a nine-visit baseline period, suggesting the value of shaping for this important sub-sample.
Contingencies for change in complacent smokers
Experimental and Clinical Psychopharmacology, 2007
The majority of smokers have no plans to quit in the near future. These complacent smokers are less likely to quit than other smokers, and few interventions are known to reduce smoking in this population. Although monetary incentives can reduce complacent smokers' breath carbon monoxide (BCO) levels, it is not clear whether these effects can be sustained beyond the several weeks that past studies have examined. The authors compared complacent smokers randomly assigned to receive incentives for BCO reductions (n ϭ 18) or noncontingent incentives (n ϭ 19) for 3 months. Contingent incentives were associated with (a) reduced BCO; (b) more BCO samples indicative of abstinence; (c) fewer cigarettes smoked and more days abstinent at study end; and (d) lower salivary cotinine. These behaviors can predict future cessation, and 2 of the 18 smokers (11%) receiving BCO-contingent incentives reported quitting as compared with none in the control group. Contingency management procedures, such as those used here, may effectively promote cessation among complacent smokers and provide a model for understanding the possible effects of some environmental interventions (like workplace smoking bans) on the behavior of complacent smokers.
Shaping smoking cessation in hard-to-treat smokers
Journal of Consulting and Clinical Psychology, 2010
Objective: Contingency management (CM) effectively treats addictions by providing abstinence incentives. However, CM fails for many who do not readily become abstinent and earn incentives. Shaping may improve outcomes in these hard-to-treat (HTT) individuals. Shaping sets intermediate criteria for incentive delivery between the present behavior and total abstinence. This should result in HTT individuals having improving, rather than poor, outcomes. We examined whether shaping improved outcomes in HTT smokers (never abstinent during a 10-visit baseline). Method: Smokers were stratified into HTT (n ϭ 96) and easier-to-treat (ETT [abstinent at least once during baseline]; n ϭ 50) and randomly assigned to either CM or CM with shaping (CMS). CM provided incentives for breath carbon monoxide (CO) levels Ͻ4 ppm (approximately 1 day of abstinence). CMS shaped abstinence by providing incentives for COs lower than the 7th lowest of the participant's last 9 samples or Ͻ4 ppm. Interventions lasted for 60 successive weekday visits. Results: Cluster analysis identified 4 groups of participants: stable successes, improving, deteriorating, and poor outcomes. In comparison with ETT, HTT participants were more likely to belong to 1 of the 2 unsuccessful clusters (odds ratio [OR] ϭ 8.1, 95% CI [3.1, 21]). This difference was greater with CM (OR ϭ 42, 95% CI [5.9, 307]) than with CMS, in which the difference between HTT and ETT participants was not significant. Assignment to CMS predicted membership in the improving ( p ϭ .002) as compared with the poor outcomes cluster. Conclusion: Shaping can increase CM's effectiveness for HTT smokers.
Sains Malaysiana, 2020
River ABSTRACT Feedback on exhaled carbon monoxide (CO) levels may potentially improve smokers’ motivation to quit. However, evidence to support its use is still lacking. This study aimed to examine how providing feedback on exhaled CO measurement affected smokers’ intention to quit and cigarette consumption short term. This non-randomised controlled trial was conducted at a government health clinic. The control group (n=132) received conventional counselling using the 5A approach and pamphlets, whereas the intervention group (n=132) received similar counselling along with feedback on exhaled CO measurements. Subjects’ intention to quit in the next month and current cigarette consumption were assessed at baseline and again four weeks post-counselling. At the baseline, there were significant differences between the groups in terms of gender (p=0.002), ethnicity (p=0.004), marital status (p=0.002), age of smoking initiation (p<0.001), nicotine dependence (p=0.001) and quit intentio...
Impact of a Brief Motivational Smoking Cessation Intervention
American Journal of Preventive Medicine, 2009
BACKGROUND-Few studies have rigorously evaluated whether providing biologically-based health risk feedback increases smokers' motivation to quit and long-term abstinence above standard interventions.
Nicotine & Tobacco Research, 2020
IntroductionMost people who smoke cigarettes are not willing (ie, not ready) to make a quit attempt (QA) at any given time. Unfortunately, interventions intended to increase QAs and the success of QAs are only modestly effective. Identifying processes leading to QAs and quitting success could guide intervention development.Aims and MethodsThis is a secondary analysis of a randomized factorial trial of 6 weeks of motivation-phase interventions among primary care patients (N = 517) who were initially unwilling to quit but were willing to reduce their smoking. Using logistic regression, we controlled for treatment condition and tested whether baseline or change in smoking-related constructs after 6 weeks of treatment predicted (1) making an at least 24 h QA between weeks 6 and 26 and (2) quitting success at week 26 (7-day point-prevalence abstinence among those who made a QA). Predictors included cigarettes/day, time to first cigarette, motivation to quit, quitting self-efficacy, anticipated urges to smoke if quit, positive affect, negative affect, and time spent around others who smoke.ResultsIn multivariable models that included all smoking-related constructs, changes in the following variables predicted initiating a QA above and beyond other variables: greater baseline time to first cigarette (odds ratio [OR] = 1.60), increases in time to first cigarette (OR = 1.27), and increases in quitting self-efficacy (OR = 1.14). Increased motivation to quit predicted conversion of a QA into quitting success at 26 weeks (OR = 1.36).ConclusionPredictors of making a QA differed from predictors of quitting success. Predictors of QAs and success could each serve as important treatment targets of motivation-phase interventions.ImplicationsMotivation-phase interventions for people initially unwilling to quit smoking cigarettes may be improved by striving to increase their (1) time to first cigarette and quitting self-efficacy to promote QAs and (2) motivation to quit to promote quit success. Future experimental tests of such interventions are needed to identify causal determinants of QAs and quitting success.
Scheduled reduced smoking: Effects on smoking abstinence and potential mechanisms of action
Addictive Behaviors, 1997
Although most smokers in our society report that they would like to quit, smoking prevalence rates have remained relatively unchanged during most of the 1990s. This is in contrast to a nearly 50% reduction in prevalence observed over the past 3 decades. Presently, an estimated 25.5% of adults (48 million people) continue to smoke, although most smokers would like to quit. Recent research on the treatment of nicotine dependence has focused primarily on events that occur after the initial cessation period (i.e., the prevention of relapse with behavioral counseling and/or the management of withdrawal symptoms with nicotine replacement therapy). Although these methods are effective, there is evidence that cessation rates may also be enhanced by manipulating smoking behavior prior to quitting. One promising approach is scheduled reduced smoking. Early work with this approach has yielded superior abstinence rates compared to gradual reduction and abrupt "cold turkey" quitting techniques. In this article, we present an overview of research on scheduled reduced smoking and discuss the effects of the treatment on smoking urges, negative affect, and selfefficacy. 0 1997 Elsevier Science Ltd Smoking is the single most preventable cause of premature earth and disability in the United States (U.S. Department of Health and Human Services, 1989). It has been implicated in one out of every six deaths, or approximately 434,000 fatalities per year (Centers for Disease Control, 1991). Nevertheless, although the prevalence of smoking has decreased dramatically over the past 25 years, this decline appears to have plateaued, at least in part because quitting smoking is difficult and the vast majority of quit attempts are unsuccessful. Seventy percent of adult smokers report that they would like to quit smoking, and 42%-46% of daily smokers make a quit attempt each year (Centers for Disease Control, 1993; 1996). However, only 5.7% of those who make a quit attempt are able to remain abstinent for at least 1 month (Centers for Disease Control, 1993). Thus, there is a pressing need for effective and readily accessible smoking-cessation treatments. New treatments must continue to be developed and evaluated. CURRENT CESSATION APPROACHES Formal smoking-cessation treatment programs typically involve nicotine replacement therapy (NRT), behavioral counseling (support and coping skills training), or a combination of these approaches. Although effective, both NRT and behavioral interventions have disadvantages. The efficacy of NRT may be compromised by side effects or cost, both of which may lead to premature discontinuation of the treatment. Recent surveys suggest that most smokers trying to quit had not used NRT (Pierce, Gilpin, & Farkas, 1995) although use may rise with recent over-the-counter availabil-Requests for reprints should be sent to
The modification of smoking behavior: Progress and problems
Addictive Behaviors, 1976
A review of recent controlled, experimental research on the modification of cigarette smoking behavior led to conclusions that (a) activity in the field is still vigorous, (b) some progress in terms of treatment effectiveness, research methodology, and target conceptualizations has been made during the past 6 yr, particularly by those adopting a social-learning approach, and (c)certain methodological and conceptual problems remain and must be eliminated if knowledge in the area is to continue to advance. 89 A.B. Vol. I, No ?-A *The general public may have reached this conclusion as well. A recent poll (Gallup, 1974) indicated that only 34% of smokers wishing to quit are interested in attending a clinic. The majority seem to prefer a "do-it-yourself" program (Schwartz & Dubitzky. 1968).
2015
AimsTo screen promising intervention components designed to reduce smoking and promote abstinence in smokers initially unwilling to quit.DesignA balanced, 4-factor, randomized factorial experiment.SettingEleven primary care clinics in southern Wisconsin, USA.Participants517 adult smokers (63% women, 91% White) recruited during primary care visits who were willing to reduce their smoking but not quit.InterventionsFour factors contrasted intervention components designed to reduce smoking and promote abstinence: 1) nicotine patch vs. none; 2) nicotine gum vs. none; 3) motivational interviewing (MI) vs. none; and 4) behavioral reduction counseling (BR) vs. none. Participants could request cessation treatment at any point during the study.MeasurementsThe primary outcome was percent change in cigarettes smoked per day at 26 weeks post-study enrollment; the secondary outcomes were percent change at 12 weeks and point-prevalence abstinence at 12 and 26 weeks post-study enrollment.FindingsThere were few main effects, but a significant 4-way interaction at 26-weeks post-study enrollment (p=.01, β = .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=.04), and nicotine gum, when used without MI, increased abstinence after a subsequent aided quit attempt (p=.01).ConclusionsMotivation-phase nicotine gum and behavioral reduction counseling are promising intervention components for smokers who are initially unwilling to quit.