Talking about change: The relationship between verbal expressions of desire to quit smoking and quitting outcomes in smokers who are not yet ready to quit

Motivational Interviewing (MI) is a method of counseling that has been shown to be effective for fostering health behavior change. MI methods have been shown to increase the elicitation of  “change talk” (CT; i.e. expressions of interest or desire to change), which has been hypothesized to be an important mechanism through which MI has its effects. Using data from a large randomized trial of different counseling methods for smoking cessation we examined the relationship between expressions of desire to change (Desire CT) during counseling and quit attempts (QA) at the end of treatment (EOT) and 26-week follow-up. Participants were daily smokers recruited from the community (N=202; mean age = 45.9; 56% men; 69% Non-White) with mean motivation to quit levels of less than 2 on a 0-10 point scale. We used the MI Skill Code (MISC v. 2.1) to code the occurrence of Desire CT in 202 baseline counseling sessions from the Health Education (HE) and MI arms. Multivariate analyses controlling for treatment arm revealed that Desire CT at baseline was predictive of QA at EOT (OR 2.16 [1.15-4.07], p = 0.017) and follow-up (OR 2.70 [1.42-5.13], p = 0.002). Desire CT remained significant in additional models including nicotine dependence and cigarettes smoked. Findings suggest that expressions of interest in change might be related to behavior change independent of treatment, cigarettes smoked, and level of dependence. Additional research should establish whether or not Desire CT is a reflection of underlying motivation or if it has a causal relationship with outcomes.