Research and treatment on cigarette smoking has typically been separated from research on alcohol and other drugs. The findings from smoking research, however, can be applied to substance use disorder research and treatment as well.
Research and treatment on cigarette smoking has typically been separated from research on alcohol and other drugs. The findings from smoking research, however, can be applied to substance use disorder research and treatment as well.
l
There are many lessons that the field of recovery research can learn from research targeting cigarette smoking despite their focus on different types of substances. These areas have informed each other in many important ways. In one well known example, the transtheoretical stages of change model, forming the basis for understanding how people become ready to change their substance use, was first developed in cigarette smokers.
One key area where smoking cessation research can inform recovery research is technology-based interventions. While mobile text message interventions can be helpful for smoking cessation, the field knows very little about how they work – i.e., what are the mechanisms of behavior change.
Text2Quit provides tailored text messages for 3 months intended to enhance an individual’s motivation and ability to cope effectively with difficult experiences related to quitting (e.g., craving). Participants could continue to seek help by texting certain keywords for 3 months following the initial treatment phase. It also provided access to a personalized website to learn more about other smoking cessation resources, specifically medication and quit lines.
This study analyzed how Text2Quit worked by conducting “mediation” analyses of four potential psychosocial mechanisms:
In addition, the authors tested whether Text2Quit worked by getting people to use one of four outside smoking cessation resources:
Control participants were provided with online access to smoking cessation education and materials.
The study included 409 adult daily smokers (5+ cigarettes per day) who were seeking ways to help them quit online. The sample was 35 years old, on average, as well as 68% female, 79% White, 70% with less than a college degree, and 62% who had made a previous quit attempt.
The primary outcome was self-reported 7-day smoking abstinence – a common outcome in smoking cessation research – 6 months after beginning the study. The mechanisms were measured at 1 month. In each case, analyses tested just one of the four psychosocial mechanisms at a time, along with the entire set of outside resources, while controlling statistically for individual differences of participants at baseline.
It is worth mentioning, in the initial randomized trial of Text2Quit, 38% of the intervention participants were abstinent at 6 months, compared to 22% in the control group.
For the mediation analyses, abstinence self-efficacy, skill/expertise, and perceived social support all helped explain the benefit of Text2Quit. Abstinence self-efficacy – enhanced confidence to quit – was the strongest mechanism, accounting for 35% of the benefit. Although none of the outside resources explained the benefit of Text2Quit, it is interesting to note that engagement with an online community focused on smoking cessation was associated with improved abstinence.
Receiving Text2Quit did not affect online community engagement, however, presumably because it was not directly addressed in the intervention.
This mediation analysis of Text2Quit showed that psychosocial processes like increased confidence to quit help explain how the intervention works, while linking people with outside smoking cessation resources did not explain its benefit.
Indeed, a recent review on mechanisms of behavior change studies in all types of technology-based interventions for tobacco, alcohol, and other drug problems, also points to the central role of psychologically mediated changes, such as enhanced abstinence self-efficacy and perceived skills to help maintain quitting.
Only one study on mobile technology was included in that review, however, as most were web-based interventions. Additionally, as authors noted, given that there were unique benefits offered both by the text message intervention as well as participation in online forums on abstinence, for example, helping people change their health behaviors may be less about suggesting one type of intervention or another, and more about understanding what combination of approaches works best and for whom.
This study focused on a text message smoking cessation intervention in people seeking online resources. Studies on other types of smokers are important, say if they were attending an appointment at the primary care doctor’s office, for example. Also, future work might build on the important findings of this study – that technology based intervention can effect changes in key psychological phenomena – to test whether that is also true in recovery research.
Hoeppner, B. B., Hoeppner, S. S., & Abroms, L. C. (2016). How do text‐messaging smoking cessation interventions confer benefit? A multiple mediation analysis of Text2Quit. Addiction.
Dr. Bettina Hoeppner is the Director of BioStatistics at the Recovery Research Institute
l
There are many lessons that the field of recovery research can learn from research targeting cigarette smoking despite their focus on different types of substances. These areas have informed each other in many important ways. In one well known example, the transtheoretical stages of change model, forming the basis for understanding how people become ready to change their substance use, was first developed in cigarette smokers.
One key area where smoking cessation research can inform recovery research is technology-based interventions. While mobile text message interventions can be helpful for smoking cessation, the field knows very little about how they work – i.e., what are the mechanisms of behavior change.
Text2Quit provides tailored text messages for 3 months intended to enhance an individual’s motivation and ability to cope effectively with difficult experiences related to quitting (e.g., craving). Participants could continue to seek help by texting certain keywords for 3 months following the initial treatment phase. It also provided access to a personalized website to learn more about other smoking cessation resources, specifically medication and quit lines.
This study analyzed how Text2Quit worked by conducting “mediation” analyses of four potential psychosocial mechanisms:
In addition, the authors tested whether Text2Quit worked by getting people to use one of four outside smoking cessation resources:
Control participants were provided with online access to smoking cessation education and materials.
The study included 409 adult daily smokers (5+ cigarettes per day) who were seeking ways to help them quit online. The sample was 35 years old, on average, as well as 68% female, 79% White, 70% with less than a college degree, and 62% who had made a previous quit attempt.
The primary outcome was self-reported 7-day smoking abstinence – a common outcome in smoking cessation research – 6 months after beginning the study. The mechanisms were measured at 1 month. In each case, analyses tested just one of the four psychosocial mechanisms at a time, along with the entire set of outside resources, while controlling statistically for individual differences of participants at baseline.
It is worth mentioning, in the initial randomized trial of Text2Quit, 38% of the intervention participants were abstinent at 6 months, compared to 22% in the control group.
For the mediation analyses, abstinence self-efficacy, skill/expertise, and perceived social support all helped explain the benefit of Text2Quit. Abstinence self-efficacy – enhanced confidence to quit – was the strongest mechanism, accounting for 35% of the benefit. Although none of the outside resources explained the benefit of Text2Quit, it is interesting to note that engagement with an online community focused on smoking cessation was associated with improved abstinence.
Receiving Text2Quit did not affect online community engagement, however, presumably because it was not directly addressed in the intervention.
This mediation analysis of Text2Quit showed that psychosocial processes like increased confidence to quit help explain how the intervention works, while linking people with outside smoking cessation resources did not explain its benefit.
Indeed, a recent review on mechanisms of behavior change studies in all types of technology-based interventions for tobacco, alcohol, and other drug problems, also points to the central role of psychologically mediated changes, such as enhanced abstinence self-efficacy and perceived skills to help maintain quitting.
Only one study on mobile technology was included in that review, however, as most were web-based interventions. Additionally, as authors noted, given that there were unique benefits offered both by the text message intervention as well as participation in online forums on abstinence, for example, helping people change their health behaviors may be less about suggesting one type of intervention or another, and more about understanding what combination of approaches works best and for whom.
This study focused on a text message smoking cessation intervention in people seeking online resources. Studies on other types of smokers are important, say if they were attending an appointment at the primary care doctor’s office, for example. Also, future work might build on the important findings of this study – that technology based intervention can effect changes in key psychological phenomena – to test whether that is also true in recovery research.
Hoeppner, B. B., Hoeppner, S. S., & Abroms, L. C. (2016). How do text‐messaging smoking cessation interventions confer benefit? A multiple mediation analysis of Text2Quit. Addiction.
Dr. Bettina Hoeppner is the Director of BioStatistics at the Recovery Research Institute
l
There are many lessons that the field of recovery research can learn from research targeting cigarette smoking despite their focus on different types of substances. These areas have informed each other in many important ways. In one well known example, the transtheoretical stages of change model, forming the basis for understanding how people become ready to change their substance use, was first developed in cigarette smokers.
One key area where smoking cessation research can inform recovery research is technology-based interventions. While mobile text message interventions can be helpful for smoking cessation, the field knows very little about how they work – i.e., what are the mechanisms of behavior change.
Text2Quit provides tailored text messages for 3 months intended to enhance an individual’s motivation and ability to cope effectively with difficult experiences related to quitting (e.g., craving). Participants could continue to seek help by texting certain keywords for 3 months following the initial treatment phase. It also provided access to a personalized website to learn more about other smoking cessation resources, specifically medication and quit lines.
This study analyzed how Text2Quit worked by conducting “mediation” analyses of four potential psychosocial mechanisms:
In addition, the authors tested whether Text2Quit worked by getting people to use one of four outside smoking cessation resources:
Control participants were provided with online access to smoking cessation education and materials.
The study included 409 adult daily smokers (5+ cigarettes per day) who were seeking ways to help them quit online. The sample was 35 years old, on average, as well as 68% female, 79% White, 70% with less than a college degree, and 62% who had made a previous quit attempt.
The primary outcome was self-reported 7-day smoking abstinence – a common outcome in smoking cessation research – 6 months after beginning the study. The mechanisms were measured at 1 month. In each case, analyses tested just one of the four psychosocial mechanisms at a time, along with the entire set of outside resources, while controlling statistically for individual differences of participants at baseline.
It is worth mentioning, in the initial randomized trial of Text2Quit, 38% of the intervention participants were abstinent at 6 months, compared to 22% in the control group.
For the mediation analyses, abstinence self-efficacy, skill/expertise, and perceived social support all helped explain the benefit of Text2Quit. Abstinence self-efficacy – enhanced confidence to quit – was the strongest mechanism, accounting for 35% of the benefit. Although none of the outside resources explained the benefit of Text2Quit, it is interesting to note that engagement with an online community focused on smoking cessation was associated with improved abstinence.
Receiving Text2Quit did not affect online community engagement, however, presumably because it was not directly addressed in the intervention.
This mediation analysis of Text2Quit showed that psychosocial processes like increased confidence to quit help explain how the intervention works, while linking people with outside smoking cessation resources did not explain its benefit.
Indeed, a recent review on mechanisms of behavior change studies in all types of technology-based interventions for tobacco, alcohol, and other drug problems, also points to the central role of psychologically mediated changes, such as enhanced abstinence self-efficacy and perceived skills to help maintain quitting.
Only one study on mobile technology was included in that review, however, as most were web-based interventions. Additionally, as authors noted, given that there were unique benefits offered both by the text message intervention as well as participation in online forums on abstinence, for example, helping people change their health behaviors may be less about suggesting one type of intervention or another, and more about understanding what combination of approaches works best and for whom.
This study focused on a text message smoking cessation intervention in people seeking online resources. Studies on other types of smokers are important, say if they were attending an appointment at the primary care doctor’s office, for example. Also, future work might build on the important findings of this study – that technology based intervention can effect changes in key psychological phenomena – to test whether that is also true in recovery research.
Hoeppner, B. B., Hoeppner, S. S., & Abroms, L. C. (2016). How do text‐messaging smoking cessation interventions confer benefit? A multiple mediation analysis of Text2Quit. Addiction.
Dr. Bettina Hoeppner is the Director of BioStatistics at the Recovery Research Institute
SIGN UP FOR THE BULLETIN
