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Cancer Control Research

5R21CA119112-02
Williams, Geoffrey C.
REAL-TIME ASSESSMENT OF AUTONOMY IN SMOKING CESSATION

Abstract

DESCRIPTION (provided by applicant): This project will compare a new methodology (Interval-Contingent Sampling Procedure-ICSP) to standard questionnaires for assessing the self-determination theory (SDT) process variables, namely autonomy support, and autonomous motivation for cessation and autonomous use of medications, during the first 5 weeks of treatment in an NCI funded tobacco dependence randomized controlled trial (RCT). The RCT builds on the results of our previous RCT of intensive treatment of smokers, and the new trial will examine biochemically validated long-term tobacco use outcomes at 12 and 24 months. The proposed study, to be contained within the new trial, would examine the assessment of motivation variables in order to compare the ICSP data assessments to questionnaire assessments in terms of their prediction of the short term abstinence outcomes. Previous results showed that the intensive SDT-based intervention significantly increased validated cessation rates (compared to community care), and that the effect was mediated by increases in perceived autonomy support and autonomous motivation. However, the effect sizes on the motivation variables were small to moderate. We expect that the ICSP assessments will provide more reliable measurements which will increase the effect sizes and allow the more precise examination of how specific aspects of the SDT-based intervention produce changes in autonomous motivation. Using ICSP assessment we will examine day-to-day changes in perceived autonomy support and autonomous motivation during the first 5 weeks of treatment in the new trial, and determine whether day to day changes in abstinence leads to autonomy, or if day to day change in autonomy leads to abstinence. Primary outcomes will be the change in autonomous motivation for cessation and medications between groups. Secondary outcomes will include exploring within person variation of autonomous motivation for cessation and use of medications and their relation to relapse to smoking. This will allow us to gain a better understanding of relapse during the early weeks after quit attempts. It will also allow us to examine more exactingly how smokers who are not ready to quit at the beginning of treatment became more motivated to quit and show greater cessation than comparable community care patients, as we found previously. Further, in the new trial, we will use pill bottle caps with electronic sensors to examine adherence to cessation medications (e.g., nicotine replacement, bupropion), which we also expect, based on our previous trial, to represent an important path to cessation and to be promoted by autonomy support and autonomous motivation. We anticipate that the ICSP assessment of the motivation variables will provide improved prediction of both medication adherence and abstinence. The potential benefits of the proposed research to public health is to more clearly understand how to motivate tobacco abstinence that will reduce mortality from three leading causes; cardiovascular disease, cancer, and emphysema. This project will compare a new methodology (Interval-Contingent Sampling Procedure) for asking people on a daily basis about their smoking to standard questionnaires for assessing their motivation for cessation and use of medications, during the first 5 weeks of tobacco dependence treatment. We anticipate that the Interval- Contingent Sampling Procedure assessment of the motivation variables will provide improved prediction of both medication use and abstinence from tobacco. The potential benefits of the proposed research to public health is to more clearly understand how to motivate tobacco abstinence that will reduce mortality from three leading causes; cardiovascular disease, cancer, and emphysema.


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