Augmenting Tobacco Cessation with Telephone-Delivered Interventions

by Patti Urso, PhD(c), RN
University of Hawaii at Manoa

Tobacco use is a serious public health problem impacting both the length and quality of life. Cigarette smoking significantly depletes American health care resources while also lowering the national state of the military readiness. In the United States, one out of every five deaths is associated with tobacco use, and many of these deaths involve a loss of 20 to 25 years of life. In light of the tremendous financial and social impacts of nicotine dependence and the limited success rates demonstrated by current interventions (the majority of cessation attempts are largely unsuccessful), an intensive approach to treatment is warranted.

The purpose of this study was to examine the enhancement of a telephone-delivered intervention administered by a nurse added to a multi-component smoking cessation program to augment abstinence and harm reduction and decrease smoking relapse. This was done by selecting a sample of sixty individuals, who were then blocked by the pharmacological aid of their choice (bupropion or transdermal patch) and then randomly assigned to one of two groups: usual care alone, as provided in the smoking cessation program, or usual care plus the weekly nurse delivered telephone intervention ("treatment" group).

With the intention-to-treat principle as the study denominator, there was no statistical significance found in the difference between point-prevalence abstinences, continuous abstinences, or the number of cigarettes smoked after ten weeks of treatment for the two groups. However, the treatment group had a higher frequency of abstinence, suggesting potential clinical value. Moods described by the participants prior to smoking relapse were correlated with the average number of days relapsed weekly, which resulted in the finding that relapse is positively strongly correlated with loneliness (r=.87) and uneasiness (r=.86).

Conclusions: Although the nurse telephone delivered interventions were not shown to be statistically significant their potential clinical value warrants further investigation. Further investigation should focus on their value in sustaining abstinence by tailoring interventions to mood.