A Novel Treatment to Boost Quit Attempts and Cessation Among Unmotivated Smokers

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DESCRIPTION (provided by applicant): Increasing smoking cessation can be accomplished not only by increasing the success of a given quit attempt but also by increasing the probability of making a quit attempt. Although policy interventions increase quit attempts, the few treatments for clinicians to motivate individual smokers to make a quit attempt have either small or inconsistent effects. This is especially problematic given the incidence of quit attempts among smokers over the past decade is not increasing. One widely used method to prompt serious quit attempts is to encourage practice-quit attempts as is done by the Great American Smoke out (GAS) and World No Smoking Day (WNSD). We hypothesize providing nicotine replacement therapy (NRT) to use in a practice-quit attempt will make the attempt more successful and less uncomfortable and thus increase the probability of later purposeful attempts to quit smoking permanently. A prior study of ours and other studies have shown that providing NRT to reduce cigarettes per day in smokers not motivated to quit increases their future quit attempts, but no one has tested whether using NRT to aid practice quit attempts also does so. We believe providing NRT will reduce distress during abstinence, produce more favorable attitudes to using NRT and increase self-efficacy for quitting. Interestingly, others have hypothesized the opposite; i.e. that the provision of NRT for goals other than life-long abstinence will decrease rather than increase future quit attempts. We propose a randomized clinical trial of a) brief advice to undertake a = 24 hr practice quit attempt or b) brief advice plus free NRT. Trial methods will be very similar to our prior study. A population-based sample of 744 unmotivated smokers will be recruited via random-digit dialing and a behavioral test to include only those with no current plans to quit. All treatments and assessments will be delivered via telephone and mailings. Though our study will assess a number of quit attempt definitions, our primary outcome is the incidence of a serious attempt to permanently stop smoking made over a six-month study period. We will also assess point prevalent abstinence as a secondary outcome and will test our hypothesized mediators of any NRT effects. If successful, this study will 1) offer a new treatment option for clinicians to motivate smokers to try to quit, 2) test whether the hypothesis that using NRT for non-abstinence outcomes undermines abstinence is correct, and 3) suggest tests of relabeling over-the-counter NRT to include use for non-cessation purposes such as practice quit attempts and tests of providing NRT samples to individuals.