Motivational support intervention to reduce smoking and increase physical activity in smokers not ready to quit: the TARS RCT

Author:

Taylor Adrian H1ORCID,Thompson Tom P1ORCID,Streeter Adam1ORCID,Chynoweth Jade1ORCID,Snowsill Tristan2ORCID,Ingram Wendy1ORCID,Ussher Michael3ORCID,Aveyard Paul4ORCID,Murray Rachael L5ORCID,Harris Tess6ORCID,Green Colin2ORCID,Horrell Jane1ORCID,Callaghan Lynne1ORCID,Greaves Colin J7ORCID,Price Lisa8ORCID,Cartwright Lucy1ORCID,Wilks Jonny1ORCID,Campbell Sarah1ORCID,Preece Dan9ORCID,Creanor Siobhan1ORCID

Affiliation:

1. Faculty of Health, Peninsula Medical School, University of Plymouth, Plymouth, UK

2. University of Exeter Medical School, University of Exeter, Exeter, UK

3. Institute for Social Marketing and Health, University of Stirling, Stirling, UK

4. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK

5. Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK

6. Population Health Research Institute, St George’s, University of London, London, UK

7. School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK

8. Sport and Health Sciences, University of Exeter, Exeter, UK

9. Public Health, Plymouth City Council, Plymouth, UK

Abstract

BackgroundPhysical activity can support smoking cessation for smokers wanting to quit, but there have been no studies on supporting smokers wanting only to reduce. More broadly, the effect of motivational support for such smokers is unclear.ObjectivesThe objectives were to determine if motivational support to increase physical activity and reduce smoking for smokers not wanting to immediately quit helps reduce smoking and increase abstinence and physical activity, and to determine if this intervention is cost-effective.DesignThis was a multicentred, two-arm, parallel-group, randomised (1 : 1) controlled superiority trial with accompanying trial-based and model-based economic evaluations, and a process evaluation.Setting and participantsParticipants from health and other community settings in four English cities received either the intervention (n = 457) or usual support (n = 458).InterventionThe intervention consisted of up to eight face-to-face or telephone behavioural support sessions to reduce smoking and increase physical activity.Main outcome measuresThe main outcome measures were carbon monoxide-verified 6- and 12-month floating prolonged abstinence (primary outcome), self-reported number of cigarettes smoked per day, number of quit attempts and carbon monoxide-verified abstinence at 3 and 9 months. Furthermore, self-reported (3 and 9 months) and accelerometer-recorded (3 months) physical activity data were gathered. Process items, intervention costs and cost-effectiveness were also assessed.ResultsThe average age of the sample was 49.8 years, and participants were predominantly from areas with socioeconomic deprivation and were moderately heavy smokers. The intervention was delivered with good fidelity. Few participants achieved carbon monoxide-verified 6-month prolonged abstinence [nine (2.0%) in the intervention group and four (0.9%) in the control group; adjusted odds ratio 2.30 (95% confidence interval 0.70 to 7.56)] or 12-month prolonged abstinence [six (1.3%) in the intervention group and one (0.2%) in the control group; adjusted odds ratio 6.33 (95% confidence interval 0.76 to 53.10)]. At 3 months, the intervention participants smoked fewer cigarettes than the control participants (21.1 vs. 26.8 per day). Intervention participants were more likely to reduce cigarettes by ≥ 50% by 3 months [18.9% vs. 10.5%; adjusted odds ratio 1.98 (95% confidence interval 1.35 to 2.90] and 9 months [14.4% vs. 10.0%; adjusted odds ratio 1.52 (95% confidence interval 1.01 to 2.29)], and reported more moderate-to-vigorous physical activity at 3 months [adjusted weekly mean difference of 81.61 minutes (95% confidence interval 28.75 to 134.47 minutes)], but not at 9 months. Increased physical activity did not mediate intervention effects on smoking. The intervention positively influenced most smoking and physical activity beliefs, with some intervention effects mediating changes in smoking and physical activity outcomes. The average intervention cost was estimated to be £239.18 per person, with an overall additional cost of £173.50 (95% confidence interval −£353.82 to £513.77) when considering intervention and health-care costs. The 1.1% absolute between-group difference in carbon monoxide-verified 6-month prolonged abstinence provided a small gain in lifetime quality-adjusted life-years (0.006), and a minimal saving in lifetime health-care costs (net saving £236).ConclusionsThere was no evidence that behavioural support for smoking reduction and increased physical activity led to meaningful increases in prolonged abstinence among smokers with no immediate plans to quit smoking. The intervention is not cost-effective.LimitationsProlonged abstinence rates were much lower than expected, meaning that the trial was underpowered to provide confidence that the intervention doubled prolonged abstinence.Future workFurther research should explore the effects of the present intervention to support smokers who want to reduce prior to quitting, and/or extend the support available for prolonged reduction and abstinence.Trial registrationThis trial is registered as ISRCTN47776579.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 27, No. 4. See the NIHR Journals Library website for further project information.

Funder

Health Technology Assessment programme

Publisher

National Institute for Health and Care Research

Subject

Health Policy

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