Treating those not ready to quit smoking: Doing harm while trying to help?

IF 4.1 2区医学 Q1 PSYCHOLOGY, CLINICAL

Addictive behaviors Pub Date : 2026-05-01 Epub Date: 2026-02-03 DOI:10.1016/j.addbeh.2026.108632

Jennifer M. Betts , Elias M. Klemperer , Timothy B. Baker , Wei-Yin Loh , Sulamunn R.M. Coleman , Jessica W. Cook

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引用次数: 0

Abstract

Introduction: Motivation-phase smoking treatment can increase treatment reach and abstinence in persons unmotivated to quit smoking. However, Motivation-phase treatment is modestly and inconsistently effective. This research aims to identify factors that may influence the effectiveness of the two intervention components most commonly used in Motivation-phase treatment: nicotine replacement therapy (NRT) and reduction counseling.

Methods: An exploratory, secondary analysis of a 4-factor, randomized trial enrolled 577 primary care patients who were willing to reduce, but not quit, smoking. Participants were randomized to the following interventions: smoking reduction counseling, nicotine mini-lozenge, behavioral activation counseling, and 5Rs-motivational counseling. Using a precision medicine approach, machine learning analyses determined whether demographic and smoking variables identified persons more likely to benefit from the interventions with regard to 24-hour quit attempts, entry into cessation treatment, and self-reported 7-day point prevalence abstinence at 1 year.

Results: Quitting self-efficacy predicted the likelihood of making a quit attempt and entering cessation treatment. At high levels of self-efficacy (>3.5 out of 5), there were no significant effects of interventions. At low levels of self-efficacy (≤3.5 out of 5), receiving reduction counseling reduced the odds of making a quit attempt (OR = 0.51, p = 0.002), and receiving mini-lozenge reduced the odds of entering cessation treatment (OR = 0.55, p = 0.02). No significant effects were found for smoking abstinence.

Conclusions: Baseline quitting self-efficacy may identify persons who will not be aided by standard Motivation-phase treatment and thus require a different therapeutic approach. These results raise questions about whom to treat, and how to treat, individuals who decline cessation treatment.

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治疗那些还没有准备好戒烟的人：在试图戒烟的同时也在伤害他们？

引言：动机阶段的吸烟治疗可以增加治疗的覆盖面和戒烟的人没有动机戒烟。然而，动机阶段的治疗是适度和不一致的有效。本研究旨在确定可能影响动机阶段治疗中最常用的两种干预成分的有效性的因素：尼古丁替代疗法（NRT）和减少咨询。方法：对一项4因素随机试验进行探索性、二次分析，纳入577名愿意减少吸烟但不戒烟的初级保健患者。参与者被随机分配到以下干预措施：减少吸烟咨询、尼古丁迷你含片、行为激活咨询和5rs动机咨询。使用精准医学方法，机器学习分析确定了人口统计学和吸烟变量是否确定了更有可能从24小时戒烟尝试、进入戒烟治疗和1年后自我报告的7天点流行戒烟方面的干预措施中受益的人。结果：戒烟自我效能感预测了戒烟尝试和进入戒烟治疗的可能性。在高水平的自我效能（bb0 - 3.5 / 5）中，干预没有显著影响。在自我效能水平较低的情况下（≤3.5 / 5），接受减量咨询降低了尝试戒烟的几率（OR = 0.51, p = 0.002），接受迷你含片降低了进入戒烟治疗的几率（OR = 0.55, p = 0.02）。戒烟没有发现明显的效果。结论：基线戒烟自我效能可以识别那些不需要标准动机阶段治疗的人，因此需要不同的治疗方法。这些结果提出了对谁进行治疗以及如何治疗拒绝戒烟治疗的个体的问题。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Addictive behaviors 医学-药物滥用

CiteScore

8.40

自引率

4.50%

发文量

283

审稿时长

46 days

期刊介绍： Addictive Behaviors is an international peer-reviewed journal publishing high quality human research on addictive behaviors and disorders since 1975. The journal accepts submissions of full-length papers and short communications on substance-related addictions such as the abuse of alcohol, drugs and nicotine, and behavioral addictions involving gambling and technology. We primarily publish behavioral and psychosocial research but our articles span the fields of psychology, sociology, psychiatry, epidemiology, social policy, medicine, pharmacology and neuroscience. While theoretical orientations are diverse, the emphasis of the journal is primarily empirical. That is, sound experimental design combined with valid, reliable assessment and evaluation procedures are a requisite for acceptance. However, innovative and empirically oriented case studies that might encourage new lines of inquiry are accepted as well. Studies that clearly contribute to current knowledge of etiology, prevention, social policy or treatment are given priority. Scholarly commentaries on topical issues, systematic reviews, and mini reviews are encouraged. We especially welcome multimedia papers that incorporate video or audio components to better display methodology or findings. Studies can also be submitted to Addictive Behaviors? companion title, the open access journal Addictive Behaviors Reports, which has a particular interest in ''non-traditional'', innovative and empirically-oriented research such as negative/null data papers, replication studies, case reports on novel treatments, and cross-cultural research.