Counseling nondaily smokers about secondhand smoke as a cessation message: a pilot randomized trial

Abstract

Introduction: Nondaily smoking represents a substantial and growing fraction of smokers, many of whom do not consider themselves smokers or at risk of tobacco-related diseases and, so, may be less responsive to counseling content contained in traditional cessation interventions. This study compares the effects brief counseling interventions (<20 min) focused on the harm smoking does to themselves (harm to self, HTS) versus the harm their secondhand smoke (SHS) does to others (harm to others, HTO) among nondaily smokers.

Methods: Randomized trial of 52 nondaily smokers (smoked in the past week, but not daily) recruited between September 2009 and June 2010; 40 completed the study. We measured changes in motivation and smoking status at 3 months postintervention.

Results: There was a difference in quitting between the two groups, with 9.5% (2 out of 21) for HTS and 36.8% (7 out of 19) for HTO subjects reporting not smoking any cigarettes in the prior week (p = .06 by Fisher exact test and .035 by likelihood-ratio chi-square). Motivation and self-efficacy increased from baseline to 3-month follow-up, but not differentially by intervention group.

Conclusions: Consistent with findings from research conducted by the tobacco industry as early as the 1970s that concluded that social smokers feel immune from the personal health effects of tobacco but are concerned about the consequences of their SHS on others, educating nondaily smokers about the dangers of SHS to others appears to be a more powerful cessation message than traditional smoking cessation counseling that emphasizes the harmful consequences to the smoker.

Figure 1.

Consort diagram. Of the 79 ineligible respondents, 46 were ineligible because they answered “yes” to the question do they smoke everyday on the telephone screen, 27 because they answered “yes” to smoking products other than tobacco (e.g., hookah, cigars), four were ineligible because the answered “no” to smoking more than 100 cigarettes in their lifetime, and two were ineligible because they answered “yes” to currently receiving treatment for their smoking elsewhere.

Figure 2.

Abstinence rates by condition. Harm to Others was associated with higher abstinence rates than Harm to Self (HTS; p = .06 by Fisher exact test and .035 by likelihood-ratio chi-square).