Benjamin A. Toll

This study evaluated whether tobacco quitline telephone coaches can be trained to counsel hazardous-drinking smokers to improve smoking cessation success and to limit or abstain from alcohol use. Smokers (N = 1,948) who called the New York State Smokers' Quitline and reported hazardous drinking (exceeding sex-specific weekly limits [14 drinks for men, 7 drinks for women] or meeting/exceeding daily drinking limits [5 drinks for men, 4 drinks for women] at least once in the past year) were randomized to receive either brief motivational counseling to limit or abstain from alcohol plus an alcohol reduction booklet added to standard care (Alcohol + Tobacco Counseling; ATC), or only smoking cessation counseling plus a smoking cessation booklet added to standard care (Tobacco-Only Counseling; TOC). Acceptable coach adherence was achieved. The intention-to-treat (ITT) analysis showed that ATC was associated with a significantly higher rate of smoking abstinence at 7-month follow-up (13.5%) compared with TOC (10.3%; p = .03). The respondent analysis (ATC= 26.2%; TOC = 20.4%) paralleled the ITT findings. When controlling for treatment condition, participants who did not report any heavy drinking were significantly more likely to quit smoking than those who reported any heavy drinking (OR = 1.87, 95% CI [1.29, 2.71]; p = .001). A brief alcohol intervention plus standard care via a telephone quitline resulted in significantly higher smoking cessation rates for hazardous-drinking callers. Given that quitline coaches were trained to provide the intervention with acceptable adherence, the potential to extend this intervention for wide-scale implementation and impact is promising.

Illnesses that are caused by smoking remain as the world's leading cause of preventable death. Smoking and tobacco use constitute approximately 30% of all cancer-related deaths and nearly 90% of lung cancer–related deaths. Thus, improving smoking cessation interventions is crucial to reduce tobacco use and assist in minimizing the burden of cancer and other diseases in the United States. This review focuses on the existing research on framed messages to promote smoking cessation. Consistent with the tenets of prospect theory and recent meta-analysis, gain-framed messages emphasizing the benefits of quitting seem to be preferable when working with adult patients who smoke tobacco products. The evidence also suggests that moderators of treatment should guide framed statements made to patients. Meta-analyses have provided consistent moderators of treatment such as need for cognition, but future studies should further define the specific framed interventions that would be most helpful for subgroups of smokers. In conclusion, instead of using loss-framed statements like “Smoking will harm your health by causing problems like lung and other cancers, heart disease, and stroke,” as a general rule, physicians should use gain-framed statements like “Quitting smoking will benefit your health by preventing problems like lung and other cancers, heart disease, and stroke.” Clin Cancer Res; 20(2); 301–9. ©2014 AACR.

Background: Previous studies have demonstrated that a low subjective response (SR) to alcohol is a risk factor for alcohol use disorders (AUDs), and a recent study suggests that acquired tolerance can be differentiated from initial SR and is also significantly associated with drinking problems. Because the prior study of SR and tolerance focused on a sample of moderate drinkers, the goal of the current study was to examine relations between early SR, acquired tolerance, alcohol use, and alcohol‐related problems in a sample of young adults with clinically significant alcohol problems.Methods: The current study examined associations between early SR and acquired tolerance and both drinking behavior and alcohol‐related problems within a sample of 113 heavy drinking young adults (66.1% male) volunteering for a clinical trial of naltrexone in combination with brief motivational counseling.Results: Consistent with the 1 prior study examining simultaneous effects of early SR and tolerance, both early SR and acquired tolerance were positively associated with typical drinking behavior, although tolerance was a much stronger predictor within this clinical sample. In contrast to the prior study, early SR was inversely associated with risk for alcohol‐related problems, and tolerance was not a significant predictor of problems.Conclusions: The results suggested that, controlling for weekly drinking, a low early SR protected against acute negative consequences within a sample of heavy drinkers who had acquired significant tolerance to alcohol effects. It is possible that this protective effect may eventually shift to a risk factor by allowing individuals with a low SR to persist in a pattern of hazardous drinking.

Background: Based on published data showing that daily smokers have high rates of hazardous drinking and higher rates of smoking relapse, we hypothesized that New York State Smokers' Quitline (NYSSQL) callers would exhibit elevated rates of risky drinking and risky drinking callers would report lower rates of smoking cessation.Methods: We assessed rates of hazardous drinking among 88,479 callers to the NYSSQL using modified NIAAA guidelines. Using 2 routine NYSSQL short‐term follow‐up interviews (n = 14,123 and n = 24,579) and a 3‐month follow‐up interview (n = 2,833), we also compared smoking cessation rates for callers who met criteria for hazardous drinking compared to moderate drinkers and nondrinkers.Results: At baseline, 56% of callers reported drinking, and 23% reported hazardous drinking using modified NIAAA guidelines. Hazardous drinkers did not differ on measures of smoking cessation outcomes compared to nondrinkers but did have lower smoking cessation rates compared to persons who reported moderate alcohol consumption for the enhanced services program 1‐week follow‐up (adjusted OR [95% CI] = 1.09 [1.01, 1.17], p = 0.04) and the standard 2‐week follow‐up (adjusted OR [95% CI] = 1.17 [1.07, 1.29], p = 0.001).Conclusions: Nearly a quarter of smokers calling the NYSSQL reported a hazardous drinking pattern, which was associated with lower cessation outcomes compared to those who reported a moderate drinking profile. Given the large number of high‐risk drinkers who can be identified through a quitline, tobacco quitlines may provide a venue for providing brief alcohol interventions to these high‐risk drinkers. Future studies should evaluate whether a brief alcohol intervention would result in improved smoking cessation rates for hazardous drinking smokers.

Smoking accounts for a large proportion of cancer-related mortality, creating a need for better smoking cessation efforts. We investigated whether gain-framed messages (ie, presenting benefits of quitting) will be a more persuasive method to encourage smoking cessation than standard-care messages (ie, presenting both costs of smoking [loss-framed] and benefits of quitting). Twenty-eight specialists working at the New York State Smokers’ Quitline (a free telephone-based smoking cessation service) were randomly assigned to provide gain-framed or standard-care counseling and print materials. Smokers (n = 2032) who called the New York State Smokers’ Quitline between March 10, 2008, and June 13, 2008, were exposed to either gain-framed (n = 810) or standard-care (n = 1222) messages, and all medically eligible callers received nicotine replacement therapy. A subset of 400 call recordings was coded to assess treatment fidelity. All treated smokers were contacted for 2-week and 3-month follow-up interviews. All statistical tests were two-sided. Specialists providing gain-framed counseling used gain-framed statements statistically significantly more frequently than those providing standard-care counseling as assessed with frequency ratings for the two types of gain-framed statements, achieving benefits and avoiding negative consequences (for achieving benefits, gain-framed mean frequency rating = 3.9 vs standard-care mean frequency rating = 1.4; mean difference = −2.5; 95% confidence interval [CI] = −2.8 to −2.3; P < .001; for avoiding negative consequences, gain-framed mean frequency rating = 1.5 vs standard-card mean frequency rating = 1.0; mean difference = −0.5; 95% CI = −0.6 to −0.3; P < .001). Gain-framed counseling was associated with a statistically significantly higher rate of abstinence at the 2-week follow-up (ie, 99 [23.3%] of the 424 in the gain-framed group vs 76 [12.6%] of the 603 in the standard-care group, P < .001) but not at the 3-month follow-up (ie, 148 [28.4%] of the 522 in the gain-framed group vs 202 [26.6%] of the 760 in the standard-care group, P = .48). Quitline specialists can be trained to provide gain-framed counseling with good fidelity. Also, gain-framed messages appear to be somewhat more persuasive than standard-care messages in promoting early success in smoking cessation.

This study focuses on comparing reports of nicotine withdrawal, craving, and depressive symptoms obtained using an Interactive Voice Response (IVR) system and several questionnaires. As part of a smoking cessation trial, daily reports of withdrawal, craving, and negative mood were collected using an IVR system for 7 days after participants attempted to quit smoking, and several pencil and paper questionnaires (i.e., the Minnesota Nicotine Withdrawal Scale, the Questionnaire on Smoking Urges, and the Center for Epidemiological Studies-Depression) were completed a week after the target quit date. The sample was composed of 378 daily smokers. Moderate to high correlations were found between the research questionnaires obtained at the end of the week and the corresponding daily IVR reports of nicotine withdrawal, craving, and depressive symptoms. However, the sample size decreased on each day of IVR reporting due to attrition. Thus, an appealing aspect of daily assessment using an IVR system is that it can provide additional data that are not obtained with paper and pencil assessments given once per week, but it will be important for future studies to concentrate on improving adherence with the IVR system in this population.

Because quitting smoking is clearly linked to preventing health problems such as lung cancer, research on health message framing based on prospect theory suggests that gain-framed messages (i.e., emphasizing the benefits of quitting smoking) would be more persuasive in promoting cessation than loss-framed messages (i.e., emphasizing the costs of continuing to smoke). However, because women tend to anticipate greater perceived risk from quitting smoking than men, this may affect how receptive they are to specific message framing interventions. Data from 249 participants (129 females, 120 males) in a clinical trial of message framing for smoking cessation with bupropion were used to examine how gender differences in perceptions of the risks associated with quitting influence the effects of framed interventions using number of days to smoking relapse as the criterion. Perceived risk of quitting scores were dichotomized using a median split for the entire sample. Women reported a higher perceived risk of cessation than men. Participants who anticipated high risks associated with quitting smoking reported fewer days to relapse. Further, females in the gain-framed condition who reported low perceived risks of cessation had a greater number of days to relapse, as opposed to females in the loss-framed condition. These findings suggest that message framing interventions for smoking cessation should consider the influence of gender and risk perceptions associated with quitting on the effectiveness of framed interventions.