Pager-cued therapeutic messages for smoking cessation
Introduction: Veterans smoke at a higher rate than California's population at large. Many are long-term, heavy smokers who have multiple previous quit attempts and are highly motivated to try new tools to help them to quit. This study represented an attempt to develop and test the feasibility of an innovative intervention that is designed to overcome barriers to quitting that plague special populations of smokers such as outpatient veterans and to improve access, affordability, and acceptability of existing smoking cessation treatments.
Topic addressed: The purpose of this pilot study was to determine the feasibility, acceptability, adherence rates, and efficacy of pager-cued therapeutic messages, using alphanumeric pagers with a group of outpatient veterans attempting to quit smoking.
Method: A total of 45 participants were enrolled in this study. Each participant was provided with an alphanumeric pager. Therapeutic messages were delivered on these pagers for a period of three months. The messages were designed to enhance motivation or readiness to quit, coping skills, problem-solving, and relapse prevention. Messages were individually tailored to the specific needs and preferences of individual participants. Participants received follow-up telephone counseling at regular intervals during the three months they were receiving the pager-cued therapeutic messages. Follow-up counseling was conducted at 1 week, 2 weeks, 3 weeks, 1 month, 2 months, and 3 months. Adherence and helpfulness ratings were obtained at 6 months.
Progress toward specific aims: At baseline, the average age of participants was 54 years. They had a packyear history of 42.2, an average of 3 prior quit attempts, and were smoking an average of 24 cigarettes per day. Stated history of alcohol or drug abuse was prevalent (62%) as was a history of depression (50%). The meanbaseline score on the revised Fagerstrom Tolerance Questionnaire was 4.3 ± 1.5 (out of a possible 7). The overall quit rate was 25.8% at 6 months. For those who report abstinence at 6 months, smoking status was biochemically-validated by saliva cotinine assay. The quit rate at 6 months was 27.3% for participants who received therapeutic messages on alphanumeric pagers and 25% for those who did not receive messages. The mean number of cigarettes smoked per day was 13.6 for participants who received messages and 14.4 for those who did not receive messages on alphanumeric pagers. Participants rated the pager-cued therapeutic messages as quite helpful (mean helpfulness rating of 7.7 ± 2.5 on 10-point scale). A total of 40% of the participants indicated that they preferred to receive pager-cued messages during the morning hours and 47% reported that they preferred the messages on weekends more than on weekdays.
Future direction: We plan to submit a grant proposal to TRDRP to investigate the effects of pager-assisted smoking cessation treatment in a randomized clinical trial.
Impact: We are encouraged by the findings of this pilot study, particularly the aggregate participant satisfaction with the pager-cued messages and its impact on smoking reduction and cessation assessed at 6 months. The use of pager-cued therapeutic messages represents a merger between technology and behaviorchange strategies designed to promote forward movement through the stages of change, maintenance of selfregulatory coping responses, and relapse prevention. |