Front-loaded versus weekly counseling for treatment of tobacco addiction

Abstract

Introduction: Approximately 60%-70% of cigarette smokers who try to quit relapse by 2 weeks postcessation. We tested the efficacy of a front-loaded (FL) counseling intervention whose goal was to increase the likelihood of successful early abstinence and subsequent long-term abstinence.

Methods: We randomized 278 adult smokers to an FL or weekly behavioral smoking cessation counseling schedule. The total number of sessions across treatment was the same for both groups. However, those assigned to the FL schedule received 6 counseling sessions in the first 2 weeks postcessation, while those in the weekly condition received 2 sessions. Participants in both groups also received standard nicotine patch treatment.

Results: At 1 year postcessation, FL participants were significantly less likely to have relapsed when continuous abstinence was used as the definition of abstinence/relapse (11.7% abstinent vs. 6.3%, hazard ratio [HR] = 0.69, p = .007); and there were nonsignificant trends for FL subjects to have better outcomes when abstinence was defined as never smoking for 7 or more consecutive days nor for 7 or more consecutive episodes (18.4% abstinent vs. 14.8%, HR = 0.83, p = .20) and as point prevalence abstinence (15.6% abstinent vs. 12.9%, p = .11). The relationship between FL counseling treatment and continuous abstinence was partially mediated by higher postcessation levels of social support perceived from counseling and greater use of cessation-related coping strategies.

Conclusions: We conclude that FL counseling is a promising treatment model that should be evaluated further, perhaps using modifications of the FL schedule used in this study.

Figure 1.

Participation flow diagram. CPD indicates cigarettes per day, HTN indicates hypertension, and TQD is target quit day.

Figure 2.

Survival distribution function by treatment condition where survival is defined based on the continuous abstinence definition of abstinence/relapse (p = .007 from Cox regression).

Figure 3.

Survival distribution function by treatment condition where survival is defined based on the National Heart, Lung, and Blood Institute (NHLBI) definition of abstinence/relapse. NHLBI abstinence is defined as never smoking for more than seven consecutive days nor for more than seven consecutive episodes (Ossip-Klein et al., 1986; p = .20 from Cox regression).

Figure 4.

Percent abstinent by treatment group across 1 year of follow-up using point prevalence abstinence as the dependent variable (p = .11 from generalized estimating equations analysis).