The importance of supporting autonomy and perceived competence in facilitating long-term tobacco abstinence

Abstract

Background: The Public Health Service (PHS) Guideline for Treating Tobacco Use and Dependence (Fiore et al. 2000) recommends supporting autonomy and perceived competence to facilitate tobacco abstinence.

Purpose: The aim of the study was to evaluate the effectiveness of an intensive tobacco-dependence intervention based on self-determination theory (SDT) and intended to support autonomy and perceived competence in facilitating long-term tobacco abstinence.

Methods: One thousand and six adult smokers were recruited into a randomized cessation-induction trial. Community care participants received cessation pamphlets and information on local treatment programs. Intervention participants received the same materials and were asked to meet four times with counselors over 6 months to discuss their health in a manner intended to support autonomy and perceived competence. The primary outcome was 24-month prolonged abstinence from tobacco. The secondary outcome was 7-day point prevalence tobacco abstinence at 24 months postintervention.

Results: Smokers in the intervention were more likely to attain both tobacco abstinence outcomes and these effects were partially mediated by change in both autonomous self-regulation and perceived competence from baseline to 6 months. Structural equation modeling confirmed the SDT model of health-behavior change in facilitating long-term tobacco abstinence.

Conclusions: An intervention based on SDT and consistent with the PHS Guideline, which was intended to support autonomy and perceived competence, facilitated long-term tobacco abstinence.

Trial registration: ClinicalTrials.gov NCT00178685.

Figure 1

CONSORT recruitment and retention of participants, reprinted from Niemiec, Ryan, Deci, and Williams (20).

Figure 2

The structural equation model, with parameter estimates, examining the structural relations among treatment condition, change in ASR and PC, medication use, and 24mPA from tobacco.

Figure 3

The structural equation model, with parameter estimates, examining the structural relations among treatment condition, change in ASR and PC, medication use, and 7dPP tobacco abstinence.