Effectiveness and cost-effectiveness of behavioural support for prolonged abstinence for smokers wishing to reduce but not quit: Randomised controlled trial of physical activity assisted reduction of smoking (TARS)
Abstract Aims For smokers unmotivated to quit, we assessed the effectiveness and cost-effectiveness of behavioural support to reduce smoking and increase physical activity on prolonged abstinence and related outcomes. Design A multi-centred pragmatic two-arm parallel randomised controlled trial. Setting Primary care and the community across four United Kingdom sites. Participants Nine hundred and fifteen adult smokers (55% female, 85% White), recruited via primary and secondary care and the community, who wished to reduce their smoking but not quit. Interventions Participants were randomised to support as usual (SAU) (n = 458) versus multi-component community-based behavioural support (n = 457), involving up to eight weekly person-centred face-to-face or phone sessions with additional 6-week support for those wishing to quit. Measurements Ideally, cessation follows smoking reduction so the primary pre-defined outcome was biochemically verified 6-month prolonged abstinence (from 3–9 months, with a secondary endpoint also considering abstinence between 9 and 15 months). Secondary outcomes included biochemically verified 12-month prolonged abstinence and point prevalent biochemically verified and self-reported abstinence, quit attempts, number of cigarettes smoked, pharmacological aids used, SF12, EQ-5D and moderate-to-vigorous physical activity (MVPA) at 3 and 9 months. Intervention costs were assessed for a cost-effectiveness analysis. Findings Assuming missing data at follow-up implied continued smoking, nine (2.0%) intervention participants and four (0.9%) SAU participants achieved the primary outcome (adjusted odds ratio, 2.30; 95% confidence interval [CI] = 0.70–7.56, P = 0.169). At 3 and 9 months, the proportions self-reporting reducing cigarettes smoked from baseline by ≥50%, for intervention versus SAU, were 18.9% versus 10.5% (P = 0.009) and 14.4% versus 10% (P = 0.044), respectively. Mean difference in weekly MVPA at 3 months was 81.6 minutes in favour of the intervention group (95% CI = 28.75, 134.47: P = 0.003), but there was no significant difference at 9 months (23.70, 95% CI = −33.07, 80.47: P = 0.143). Changes in MVPA did not mediate changes in smoking outcomes. The intervention cost was £239.18 per person, with no evidence of cost-effectiveness. Conclusions For United Kingdom smokers wanting to reduce but not quit smoking, behavioural support to reduce smoking and increase physical activity improved some short-term smoking cessation and reduction outcomes and moderate-to-vigorous physical activity, but had no long-term effects on smoking cessation or physical activity.
Citation
@article{a.h.2023,
author = {Taylor, A. H. and Thompson, T. P. and Streeter, A. and
Chynoweth, J. and Snowsill, T. and Ingram, W. and Ussher, M. and
Aveyard, P. and Murray, R. L. and Harris, T. and Callaghan, L. and
Green, C. and Greaves, C. J. and Price, L. and Creanor, S.},
title = {Effectiveness and Cost-Effectiveness of Behavioural Support
for Prolonged Abstinence for Smokers Wishing to Reduce but Not Quit:
{Randomised} Controlled Trial of Physical Activity Assisted
Reduction of Smoking {(TARS)}},
journal = {Addiction},
date = {2023-03-05},
url = {https://tristansnowsill.co.uk/effectiveness-and-cost-effectiveness-of-behavioural.html},
doi = {10.1111/add.16129},
langid = {en},
abstract = {Abstract Aims For smokers unmotivated to quit, we assessed
the effectiveness and cost-effectiveness of behavioural support to
reduce smoking and increase physical activity on prolonged
abstinence and related outcomes. Design A multi-centred pragmatic
two-arm parallel randomised controlled trial. Setting Primary care
and the community across four United Kingdom sites. Participants
Nine hundred and fifteen adult smokers (55\% female, 85\% White),
recruited via primary and secondary care and the community, who
wished to reduce their smoking but not quit. Interventions
Participants were randomised to support as usual (SAU) (n = 458)
versus multi-component community-based behavioural support (n =
457), involving up to eight weekly person-centred face-to-face or
phone sessions with additional 6-week support for those wishing to
quit. Measurements Ideally, cessation follows smoking reduction so
the primary pre-defined outcome was biochemically verified 6-month
prolonged abstinence (from 3–9 months, with a secondary endpoint
also considering abstinence between 9 and 15 months). Secondary
outcomes included biochemically verified 12-month prolonged
abstinence and point prevalent biochemically verified and
self-reported abstinence, quit attempts, number of cigarettes
smoked, pharmacological aids used, SF12, EQ-5D and
moderate-to-vigorous physical activity (MVPA) at 3 and 9 months.
Intervention costs were assessed for a cost-effectiveness analysis.
Findings Assuming missing data at follow-up implied continued
smoking, nine (2.0\%) intervention participants and four (0.9\%) SAU
participants achieved the primary outcome (adjusted odds ratio,
2.30; 95\% confidence interval {[}CI{]} = 0.70–7.56, P = 0.169). At
3 and 9 months, the proportions self-reporting reducing cigarettes
smoked from baseline by ≥50\%, for intervention versus SAU, were
18.9\% versus 10.5\% (P = 0.009) and 14.4\% versus 10\% (P = 0.044),
respectively. Mean difference in weekly MVPA at 3 months was 81.6
minutes in favour of the intervention group (95\% CI = 28.75,
134.47: P = 0.003), but there was no significant difference at 9
months (23.70, 95\% CI = −33.07, 80.47: P = 0.143). Changes in MVPA
did not mediate changes in smoking outcomes. The intervention cost
was £239.18 per person, with no evidence of cost-effectiveness.
Conclusions For United Kingdom smokers wanting to reduce but not
quit smoking, behavioural support to reduce smoking and increase
physical activity improved some short-term smoking cessation and
reduction outcomes and moderate-to-vigorous physical activity, but
had no long-term effects on smoking cessation or physical activity.}
}