Stephen J Lepore1, Bradley N Collins2, David W Sosnowski3. 1. Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Ave, 9th Floor Ritter Annex, Philadelphia, PA 19122, USA. Electronic address: slepore@temple.edu. 2. Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Ave, 9th Floor Ritter Annex, Philadelphia, PA 19122, USA. Electronic address: collinsb@temple.edu. 3. Department of Psychology, Virginia Commonwealth University, 806 W. Franklin St, Box 842018, Richmond, VA 23284, USA. Electronic address: sosnowskid@mymail.vcu.edu.
Abstract
BACKGROUND: This study investigated the effects of a multi-level smoking intervention on mediators of long-term abstinence in parental smokers, including smoking cessation self-efficacy, smoking urge coping, and perceived support to quit smoking. METHODS: This is a secondary analysis of data from a randomized trial that recruited parental smokers from pediatric clinics in low-income communities (N = 327, 83% women, 83% African American, 79% below poverty level). Following clinical practice guidelines for tobacco intervention ("Ask, Advise, Refer" [AAR]), pediatricians asked all parents about child tobacco smoke exposure (TSE), advised about TSE harms and benefits of reducing TSE, and referred smokers to cessation resources. Eligible parents were then randomized to additional telephone-based smoking behavior counseling (AAR + counseling) or nutrition education (AAR + control). Bioverified 7-day point prevalence smoking abstinence and perceived counselor support were assessed at 12-month follow-up; cessation self-efficacy and urge coping were assessed at 3-month follow-up. RESULTS: Relative to AAR + control, AAR + counseling was associated with higher self-efficacy, urge coping, and perceived support to quit (all p's<.001). Self-efficacy, but no other mediators, had a significant positive effect on 12-month bioverified smoking abstinence (p < .001). The indirect effect of intervention on 12-month abstinence via self-efficacy suggested mediation via this pathway (p = .002). CONCLUSION: Results suggest that all putative treatment pathways were improved more by the multi-level AAR + counseling than the clinic-level AAR + control intervention. Further, self-efficacy at end-of-treatment prospectively predicted long-term cessation, suggesting that building of self-efficacy through treatment may be key to sustained cessation.
RCT Entities:
BACKGROUND: This study investigated the effects of a multi-level smoking intervention on mediators of long-term abstinence in parental smokers, including smoking cessation self-efficacy, smoking urge coping, and perceived support to quit smoking. METHODS: This is a secondary analysis of data from a randomized trial that recruited parental smokers from pediatric clinics in low-income communities (N = 327, 83% women, 83% African American, 79% below poverty level). Following clinical practice guidelines for tobacco intervention ("Ask, Advise, Refer" [AAR]), pediatricians asked all parents about childtobacco smoke exposure (TSE), advised about TSE harms and benefits of reducing TSE, and referred smokers to cessation resources. Eligible parents were then randomized to additional telephone-based smoking behavior counseling (AAR + counseling) or nutrition education (AAR + control). Bioverified 7-day point prevalence smoking abstinence and perceived counselor support were assessed at 12-month follow-up; cessation self-efficacy and urge coping were assessed at 3-month follow-up. RESULTS: Relative to AAR + control, AAR + counseling was associated with higher self-efficacy, urge coping, and perceived support to quit (all p's<.001). Self-efficacy, but no other mediators, had a significant positive effect on 12-month bioverified smoking abstinence (p < .001). The indirect effect of intervention on 12-month abstinence via self-efficacy suggested mediation via this pathway (p = .002). CONCLUSION: Results suggest that all putative treatment pathways were improved more by the multi-level AAR + counseling than the clinic-level AAR + control intervention. Further, self-efficacy at end-of-treatment prospectively predicted long-term cessation, suggesting that building of self-efficacy through treatment may be key to sustained cessation.
Authors: Cendrine D Robinson; Wallace B Pickworth; Stephen J Heishman; David W Wetter; Paul M Cinciripini; Yisheng Li; Brigid Rowell; Andrew J Waters Journal: Nicotine Tob Res Date: 2015-08 Impact factor: 4.244
Authors: Megan E Piper; Tanya R Schlam; Jessica W Cook; Stevens S Smith; Daniel M Bolt; Wei-Yin Loh; Robin Mermelstein; Linda M Collins; Michael C Fiore; Timothy B Baker Journal: Drug Alcohol Depend Date: 2016-11-25 Impact factor: 4.492
Authors: David M Homa; Linda J Neff; Brian A King; Ralph S Caraballo; Rebecca E Bunnell; Stephen D Babb; Bridgette E Garrett; Connie S Sosnoff; Lanqing Wang Journal: MMWR Morb Mortal Wkly Rep Date: 2015-02-06 Impact factor: 17.586
Authors: Stephen J Lepore; Bradley N Collins; Donna L Coffman; Jonathan P Winickoff; Uma S Nair; Beth Moughan; Tyra Bryant-Stephens; Daniel Taylor; David Fleece; Melissa Godfrey Journal: Int J Environ Res Public Health Date: 2018-06-12 Impact factor: 3.390