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01-04-2011 | Original Article

New Methods for Tobacco Dependence Treatment Research

Authors: Timothy B. Baker, Ph.D., Robin Mermelstein, Ph.D., Linda M. Collins, Ph.D., Megan E. Piper, Ph.D., Douglas E. Jorenby, Ph.D., Stevens S. Smith, Ph.D., Bruce A. Christiansen, Ph.D., Tanya R. Schlam, Ph.D., Jessica W. Cook, Ph.D., Michael C. Fiore, MD, MPH, MBA

Published in: Annals of Behavioral Medicine | Issue 2/2011

Abstract

Introduction

Despite advances in tobacco dependence treatment in the past two decades, progress has been inconsistent and slow. This paper reviews pervasive methodological issues that may contribute to the lack of timely progress in tobacco treatment science including the lack of a dynamic model or framework of the cessation process, inefficient study designs, and the use of distal outcome measures that poorly index treatment effects. The authors then present a phase-based cessation framework that partitions the cessation process into four discrete phases based on current theories of cessation and empirical data. These phases include: (1) Motivation, (2) Precessation, (3) Cessation, and (4) Maintenance.

Discussion

Within this framework, it is possible to identify phase-specific challenges that a smoker would encounter while quitting smoking, intervention components that would address these phase-specific challenges, mechanisms via which such interventions would exert their effects, and optimal outcome measures linked to these phase-specific interventions. Investigation of phase-based interventions can be accelerated by using efficient study designs that would permit more timely development of an optimal smoking cessation treatment package.

There is evidence that as abstinence continues there may be intrinsic processes that thwart lapsing or relapsing and that this results in a point at which relapse becomes relatively unlikely [28]. Thus, it is possible that with very long interventions, treatment will take the majority of individuals past this point and result in very durable effect sizes (e.g., [11, 47]).

Some smokers make quit attempts in an apparently spontaneous manner. They do not select a quit day nor formally state an intention to quit [52‐54]. The current model is designed to organize and assess interventions and intervention evaluations. Obviously, there would be little opportunity to organize Precessation interventions for the person who makes an unplanned quit attempt, and the framework would not, by itself, indicate the motivational factors that resulted in such a quit attempt. A theory such as the transtheoretical model would be more appropriate for that purpose.

Other bases could have been used for the demarcation of phases. For instance, the Transtheoretical model defines stages based upon both pragmatic considerations, such as a person’s willingness or attempt to quit, and upon patterns of change processes over time [51]. We also emphasize a pragmatic strategy, one based on clinically useful distinctions, in order to promote more general buy-in by diverse investigators, which might lead to greater adoption of a common framework and complementary research efforts.

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Title: New Methods for Tobacco Dependence Treatment Research
Authors: Timothy B. Baker, Ph.D.
Robin Mermelstein, Ph.D.
Linda M. Collins, Ph.D.
Megan E. Piper, Ph.D.
Douglas E. Jorenby, Ph.D.
Stevens S. Smith, Ph.D.
Bruce A. Christiansen, Ph.D.
Tanya R. Schlam, Ph.D.
Jessica W. Cook, Ph.D.
Michael C. Fiore, MD, MPH, MBA
Publication date: 01-04-2011
Publisher: Springer-Verlag
Published in: Annals of Behavioral Medicine / Issue 2/2011
Print ISSN: 0883-6612
Electronic ISSN: 1532-4796
DOI: https://doi.org/10.1007/s12160-010-9252-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

New Methods for Tobacco Dependence Treatment Research

Abstract

Introduction

Discussion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Discussion

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