To assess the effects of adding motivational interviewing (MI) counseling to nicotine patch for smoking cessation among homeless smokers.
Two-group randomized controlled trial with 26-week follow-up.
A total of 430 homeless smokers from emergency shelters and transitional housing units in Minneapolis/St Paul, Minnesota, USA.
All participants received 8-week treatment of 21-mg nicotine patch. In addition, participants in the intervention group received six individual sessions of MI counseling which aimed to increase adherence to nicotine patches and to motivate cessation. Participants in the standard care control group received one session of brief advice to quit smoking. Primary outcome was 7-day abstinence from cigarette smoking at 26 weeks, as validated by exhaled carbon monoxide and salivary cotinine.
Using intention-to-treat analysis, verified 7-day abstinence rate at week 26 for the intervention group was non-significantly higher than for the control group (9.3% versus 5.6%, P = 0.15). Among participants who did not quit smoking, reduction in number of cigarettes from baseline to week 26 was equally high in both study groups (−13.7 ± 11.9 for MI versus −13.5 ± 16.2 for standard care).
Adding motivational interviewing counseling to nicotine patch did not increase smoking rate significantly at 26-week follow-up for homeless smokers.
"However, among pregnant smokers and young parents, there is no evidence for ME's effectiveness over other interventions (Lumley et al., 2009), and the empirical support for ME smoking cessation interventions with psychiatric populations (Baker et al., 2006), substance users (Haug, Svikis, & Diclemente, 2004; Stein et al., 2006), and general samples of primary care and hospital patients (Heckman et al., 2010) has not been established . To date, there are only a limited number of studies that have specifically focused on testing ME smoking cessation interventions for low-SES smokers (Okuyemi et al., 2007, 2013), and none that we were able to identify, which delivered ME treatment to low-income populations in primary health care centers. The current study tested the relative efficacy of two adjunctive interventions among low-SES smokers (uninsured or Medicaid) seen in a primary care setting. "
[Show abstract][Hide abstract] ABSTRACT: Despite decades of tobacco use decline among the general population in the United States, tobacco use among low-income populations continues to be a major public health concern. Smoking rates are higher among individuals with less than a high school education, those with no health insurance, and among individuals living below the federal poverty level. Despite these disparities, smoking cessation treatments for low-income populations have not been extensively tested. In the current study, the efficacy of two adjunctive smoking cessation interventions was evaluated among low-income smokers seen in a primary care setting.
A total of 846 participants were randomly assigned either to motivational enhancement treatment plus brief physician advice and 8 weeks of nicotine replacement therapy (NRT) or to standard care-consisting of brief physician advice and 8 weeks of NRT. Tobacco smoking abstinence was at 1, 2, 6, and 12 months following baseline.
The use of the nicotine patch, telephone counseling, and positive decisional balance were predictive of increased abstinence rates, and elevated stress levels and temptation to smoke in both social/habit and negative affect situations decreased abstinence rates across time. Analyses showed intervention effects on smoking temptations, length of patch use, and number of telephone contacts. Direct intervention effects on abstinence rates were not significant, after adjusting for model predictors and selection bias due to perirandomization attrition.
Integrating therapeutic approaches that promote use of and adherence to medications for quitting smoking, and which target stress management and reducing negative affect may enhance smoking cessation among low-income smokers.
[Show abstract][Hide abstract] ABSTRACT: Although over 70% of homeless individuals smoke, few studies have examined the effectiveness of smoking cessation interventions in this vulnerable population. The purpose of this pilot study was to compare the effectiveness of shelter-based smoking cessation clinic usual care (UC) to an adjunctive contingency management (CM) treatment that offered UC plus small financial incentives for smoking abstinence. Sixty-eight homeless individuals in Dallas, Texas (recruited in 2012) were assigned to UC (n = 58) or UC plus financial incentives (CM; n = 10) groups and were followed for 5 consecutive weeks (1 week pre-quit through 4 weeks post-quit). A generalized linear mixed model regression analysis was conducted to compare biochemically-verified abstinence rates between groups. An additional model examined the interaction between time and treatment group. The participants were primarily male (61.8%) and African American (58.8%), and were 49 years of age on average. There was a significant effect of treatment group on abstinence overall, and effects varied over time. Follow-up logistic regression analyses indicated that CM participants were significantly more likely than UC participants to be abstinent on the quit date (50% vs. 19% abstinent) and at 4 weeks post-quit (30% vs. 1.7% abstinent). Offering small financial incentives for smoking abstinence may be an effective way to facilitate smoking cessation in homeless individuals.
[Show abstract][Hide abstract] ABSTRACT: To explore the associations between shelter proximity and real-time affect during a specific smoking quit attempt among 22 homeless adults.
Affect was measured via 485 smartphone-based Ecological Momentary Assessments randomly administered during the weeks immediately before and after the quit day, and proximity to the shelter was measured via GPS. Adjusted linear mixed model regressions examined associations between shelter proximity and affect.
Closer proximity to the shelter was associated with greater negative affect only during the post-quit attempt week (p = .008). All participants relapsed to smoking by one week post-quit attempt.
Among homeless smokers trying to quit, the shelter may be associated with unexpected negative affect/stress. Potential intervention applications are suggested.
American journal of health behavior 03/2014; 38(2):161-9. DOI:10.5993/AJHB.38.2.1 · 1.31 Impact Factor
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