A randomized trial of assertive intervention approaches with non treatment seeking 18 to 24 year old tobacco users: 3 month tobacco cessation outcomes

Abstract:

Purpose: The study aimed to: (1) assess if assertive intervention could motivate non treatment seeking young adult tobacco users with lower incomes and education to participate in evidence based quit programs; and (2) to determine if there were outcome differences between two commonly utilized intervention approaches.

Methods –Inclusion/exclusion criteria included: age (18 to 24); non college graduates; and having smoked at least 1 cigarette in the past month. A convenience sample of 192 clients in six rural counties was recruited by six health educators through street outreach, and were block randomized to one of two conditions: (1) referral to a national tobacco cessation Quitline (N=90) or (2) direct cessation intervention provided by the counselor (N=102). Participants completed a baseline assessment of tobacco use practices and were followed 3 months post baseline. A 3-month follow-up tobacco use status was validated through random saliva testing.

Results – Overall, 78% of the participants completed the 3 month follow-up and 16.3% quit smoking (20.7% of the tobacco users in the direct intervention condition quit compared to 10.2% using Quitline.). A logistic regression analysis found that condition assignment was the strongest predictor of quitting and that participants in the direct intervention condition were statistically (p=.03) more likely to quit after controlling for other factors.

Implications – Direct assertive intervention led to more than a 100% increase in quit rates over referrals to Quitline. Application of assertive intervention to specific populations could increase tobacco quit rates for smokers with lower incomes and education.