The 2016 Ferno Award Address: Three Things

Abstract

Researchers may optimize smoking treatment by addressing three research topics that have been relatively neglected. First, researchers have neglected to intensively explore how counseling contents affect smoking cessation success. Worldwide, millions of smokers are exposed to different smoking cessation contents and messages, yet existing research evidence does not permit strong inference about the value of particular counseling contents or strategies. Research in this area could enhance smoking outcomes and yield new insights into smoking motivation. Second, researchers have focused great attention on inducing smokers to make quit attempts when they contact healthcare systems; the success of such efforts may have plateaued. Also, the vast majority of quit attempts are self-quit attempts, largely unsuccessful, that occur outside such contacts. Researchers should explore strategies for using healthcare systems as conduits for digital- and other population-based interventions independent of healthcare visits. Such resources should be used to graft timely access to evidence-based intervention onto self-quitting, yielding evidence-based, patient-managed quit attempts. Third, most smoking treatments are assembled via selection of components based on informal synthesis of empirical and impressionistic evidence and are evaluated as a package. However, recent factorial experiments show that components of smoking treatments often interact meaningfully; for example, some components may interfere with the effectiveness of other components. Many extant treatments likely comprise suboptimal sets of components; future treatment development should routinely use factorial experiments to permit the assembly of components that yield additive or synergistic effects.Research in the above three areas should significantly advance our understanding of tobacco use and its treatment.

Implications: A lack of relevant research, and the likely prospect of significant clinical and public health benefit, underscore the importance of performing research on three topics related to smoking intervention: (1) researchers need to identify which contents of smoking counseling are effective; (2) researchers need to devise innovative strategies that use healthcare systems as conduits of smoking treatment delivery outside of clinical contacts; and (3) researchers need to use factorial designs to guide their development of smoking treatments. Research on these topics should yield complementary evidence that guides the development of more effective smoking treatments.

Figure 1.

CONSORT for patient flow in EHR recruitment study.

Figure 2.

(a) Bar graphs for gum × behavioral reduction (BR). (b) Bar graph for gum × motivational interviewing (MI).

Figure 3.

Mean percent reduction in cigarettes per day (CPD) at week 26. BR = behavioral reduction; MI = motivational interviewing.