Cigarette smoking in the United States dropped from 2005 to 2015, according to the CDC and Gallup, with the largest drop for young adults age 18-29. But a 2015 Ipsos poll found that smoking rates are higher among Millennials (age 18-34) than for any other age group and that Millennials are much more likely to hide their smoking from co-workers.
Differences between Millennial and older smokers raise the possibility that a one-size-fits-all approach is not ideal for helping people quit smoking. UMN Psychology Professor Alexander Rothman advocates a systematic, experimental medicine-based approach to helping people quit that aims to identify what treatments work, why, for whom, and under what conditions, in order to design a range of programs that provide the right help for different people in different circumstances.
The approach involves first identifying two things: the desired target of the intervention (for example, how we want people to think or feel so they will be able to quit smoking) and how to get the intervention to the target (how to get people to think or feel that way). Next, researchers determine under what conditions the intervention they are studying reaches the target (the intervention changes how people think or feel) and under what conditions this process produces the desired behavior (the change in how people think or feel leads to successfully quitting smoking).
In a recent paper, Dr. Rothman, former graduate student Dr. Rachel Burns, and their collaborators describe using this approach to identify who benefits from an extended smoking cessation program (“longitudinal care”). Smokers who wanted to quit were assigned to either a traditional 8-week treatment program or a longitudinal care program with treatment available for up to a year. Both interventions tended to increase participants’ satisfaction with their effort and confidence in their ability to quit, and both of these mental states increased the likelihood of quitting smoking. But the big difference was for people who were struggling to quit: these people benefitted more from longitudinal care than the standard 8-week program. It would be useful, then, to triage smokers trying to quit and identify those who only need the traditional intervention—or even a less intensive intervention—and those who would benefit from longitudinal care.
A current project of Dr. Rothman’s seeks to provide data to inform this triage. Funded by a grant from the National Cancer Institute, Dr. Rothman and collaborators at UMN and other institutions plan to systematically test different smoking cessation treatments for a group of smokers who choose to participate in a lung cancer screening program. All of the participants in this study will start with the current state-of-the-art program, involving phone counseling and over-the-counter nicotine replacement products. After a period of time, the researchers plan to identify who is and is not responding to this treatment. Non-responders will be assigned to either continue in the program as before or receive an additional intervention. Responders will be assigned to either continue in the program as before or reduce the intensity of the intervention. This method allows the research team to test different levels of intervention for different people based on which interventions already work or do not work for them. By developing a more systematic understanding of who needs what, Dr. Rothman and his collaborators can provide information that practitioners can use to make treatment recommendations in different circumstances that can be more effective and more efficient in helping them quit.
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