A randomized controlled trial of an optimized smoking treatment delivered in primary care

Megan E. Piper, Jessica W. Cook, Tanya R. Schlam, Douglas E. Jorenby, Stevens S. Smith, Linda M. Collins, Robin Mermelstein, David Fraser, Michael C. Fiore, Timothy B. Baker

Research output: Contribution to journalArticlepeer-review


Background: The effectiveness of smoking cessation treatment is limited in real-world use, perhaps because we have not selected the components of such treatments optimally nor have treatments typically been developed for and evaluated in real-world clinical settings.

Purpose: To validate an optimized smoking cessation treatment package that comprises intervention components identified as effective in factorial screening experiments conducted as per the Multiphase Optimization Strategy (MOST).

Methods: Adult smokers motivated to quit were recruited from primary care clinics (N = 623). Participants were randomized to receive either recommended usual care (R-UC; 10 min of in-person counseling, 8 weeks of nicotine patch, and referral to quitline services) or abstinence-optimized treatment (A-OT; 3 weeks of prequit mini-lozenges, 26 weeks of nicotine patch + mini-lozenges, three in-person and eight phone counseling sessions, and 7-11 automated calls to prompt medication use). The key outcomes were self-reported and biochemically confirmed (carbon monoxide, CO <6 ppm) 7-day point-prevalence abstinence.

Results: A-OT participants had significantly higher self-reported abstinence rates than R-UC participants at 4, 8, 16, and 26 weeks (ORs: 1.91-3.05; p <. 001). The biochemically confirmed 26-week abstinence rates were lower than the self-reported 26-week rates, but revealed a similar treatment effect size (OR = 2.94, p < .001). There was no moderation of treatment effects on 26-week abstinence by demographic, psychiatric, or nicotine dependence variables. A-OT had an incremental cost-effectiveness ratio for 26-week CO-confirmed abstinence of $7,800.

Conclusions: A smoking cessation treatment that is optimized via MOST development meaningfully enhances cessation rates beyond R-UC smoking treatment in smokers seen in primary care.

Clinical Trial Registration: NCT02301403.

Original languageEnglish (US)
Pages (from-to)854-864
Number of pages11
JournalAnnals of Behavioral Medicine
Issue number10
StatePublished - Sep 13 2018


  • Combination nicotine replacement
  • Multiphase optimization strategy
  • Primary care
  • Randomized controlled trial
  • Smoking cessation
  • Outcome and Process Assessment, Health Care
  • Cigarette Smoking/therapy
  • Tobacco Use Cessation Devices
  • Humans
  • Middle Aged
  • Male
  • Combined Modality Therapy
  • Counseling/methods
  • Smoking Cessation/methods
  • Adult
  • Female
  • Primary Health Care/methods

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • General Psychology


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