Effect of Helpers Program On-line Training on Smoking Relapse and Social Networks

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Abstract Despite major gains in smoking cessation treatment, over half of recently quit smokers will relapse within the first year. Two systematic reviews of relapse prevention studies came to different conclusions on effectiveness of behavioral interventions. Existing evidence in relapse prevention is limited by study designs, methodology, and conceptual approaches to behavioral interventions. Different approaches to relapse prevention studies, and to the interventions themselves are needed to advance the long-term understanding and outcomes of smoking relapse prevention. To date, relapse prevention interventions have focused on the newly abstinent smoker (“abstainer”), and not attempted to directly or indirectly influence the abstainer’s personal network (PN), e.g. by helping the abstainer influence others in their PN to quit. Personal networks exert powerful effects on initiating and maintaining smoking behavior, and can facilitate maintaining abstinence or trigger relapse. A “help others” intervention that seeks to increase the abstainer’s ability to influence smokers in their PN to quit – thereby creating a PN social environment more supportive of long-term abstinence - may have a beneficial effect on relapse. The Helpers SQ intervention encourages abstainers to reinforce their own abstinence through helping others quit, and to proactively influence their PN to be more conducive to long-term smoking abstinence. Framing relapse as a dynamic and complex process, the Helpers Stay Quit (Helpers SQ) intervention is a conceptually novel approach to relapse prevention that integrates different behavioral theories into a multifaceted intervention model presented as an on-line tobacco cessation brief intervention training. Helpers SQ teaches abstainers how to encourage other tobacco users to quit and avoid relapse through a non- confrontational “helping conversation” (HC) that encourages quitting and use of evidence-based cessation aids (e.g. quitlines, cessation medications) without confrontation and nagging. Our pilot feasibility study of Helpers SQ (N=104) with abstainers from Arizona’s state quitline compared 30-day abstinence at 7-months with a propensity score matched sample from quitline clients not exposed to Helpers SQ. Preliminary results: Helpers SQ participants reported higher 30-day abstinence than non-participants (82% vs. 36%, Difference = 46% [95% CI: 37%, 56%, p<0.0001]). Encouraged by these results, we hypothesize that quitline abstainers exposed to Helpers SQ will have higher 30-day and 7-day point prevalence abstinence than those receiving quitline follow-up usual care, and that the effect of Helpers SQ may be mediated by PN characteristics. To test this hypothesis, we propose a pragmatic randomized controlled trial (N=940) with embedded mixed-methods PN study to assess the effect of Helpers SQ training on proportion and duration of abstainers’ abstinence over time, and on abstainer’s PN interactions related to smoking and smoking cessation. Metrics derived from the PN study will be used for mediational analyses of overall, and gender-based effects of Helpers SQ on smoking relapse.