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Research Project

Testing Intervention Components for the Smoker Who Is Unwilling to Quit

Principal Investigator
Mermelstein, Robin J
Start Date
End Date


Most smokers making a routine healthcare visit are not ready to quit smoking. This research will test promising treatments designed to motivate such smokers to reduce their smoking, make quit attempts, and quit successfully. These treatments will increase the number of primary care patients who quit smoking and will reduce cancer deaths caused by tobacco.

The following abstract discusses Project 2, directed by Dr. Mermelstein, of a larger research program project, or P01, at the University of Wisconsin, Madison, directed by Dr. Michael C. Fiore. Learn more about the P01 on the NIH website.

Cigarette smoking is the leading preventable cause of cancer and accounts for over $96 billion in annual direct medical costs in the US. To reduce the enormous health and economic harms of smoking, we need a comprehensive approach to engage all smokers visiting healthcare settings in treatment that efficiently and effectively helps them stop smoking. Unfortunately, most smokers making a healthcare visit are unwilling to make a serious quit attempt, and there are few empirically validated treatments to motivate them to quit and prepare them to quit successfully. In sum, we do not know which intervention components are optimal for smokers unwilling to quit, a group that comprises the majority of smokers at any point in time.

Project 2 of the program project aims to identify highly effective intervention components for smokers initially unwilling to quit. Smokers (N=512) making routine healthcare visits to primary care clinics who are unwilling to quit will be identified and recruited using an enhanced electronic health record (EHR). Consistent with the Multiphase Optimization Strategy (MOST), we will use a highly efficient factorial design (2x2x2x2) to test four different intervention components:

  1. Type of Nicotine Replacement (Nicotine Gum vs. Nicotine Mini-Lozenge)
  2. Behavioral Reduction Counseling (off/on)
  3. SRs Motivation Counseling (off/on)
  4. Behavioral Activation Counseling (off/on).

These components have strong theoretical and empirical support, but their relative, additive, and interactive effects are unknown. The most promising of these components will be integrated with additional components tested in the other projects in this P01 to form a chronic care treatment that provides effective treatment for all phases of smoking intervention: from motivating quitting to recovering from relapse.

Project 2 is linked to other projects in this P01 with a planned interlocking design: as participants express readiness to quit in Project 2 (this study), they will receive the cost-optimized cessation treatment in Project 3. Thus, not only will we identify intervention components that produce the greatest smoking reduction and quit attempts, we will also identify which components help smokers benefit from the next element in a chronic care model for smoking treatment.

Funding Source

National Cancer Institute of the National Institutes of Health (Grant No. P01CA180945)

Title of parent grant

Optimized Chronic Care For Smokers: A Comparative Effectiveness Approach

Principal investigator of parent grant

Michael C. Fiore, MD, MPH

Institution of principal investigator (Non-UIC)

University of Wisconsin at Madison (Center for Tobacco Research and Intervention, or CTRI)

Related Publication(s)

Engle JL, Mermelstein R, Baker TB, Smith SS, Schlam TR, Piper ME, et al. Effects of motivation phase intervention components on quit attempts in smokers unwilling to quit: A factorial experiment. Drug Alcohol Depend. 2019 Apr 1;197:149-157. doi: 10.1016/j.drugalcdep.2019.01.011.

Piper ME, Cook JW, Schlam TR, et al. A Randomized Controlled Trial of an Optimized Smoking Treatment Delivered in Primary Care. Ann Behav Med. ;52(10):854–864. doi:10.1093/abm/kax059.

Petersen A, Mermelstein R, Berg KM, Baker TB, Smith SS, Jorenby D, et al. Offering smoking treatment to primary care patients in two Wisconsin healthcare systems: Who chooses smoking reduction versus cessation? Prev Med. 2017 Dec;105:332-336. doi: 10.1016/j.ypmed.2017.10.015.

Baker TB, Smith SS, Bolt DM, Loh WY, Mermelstein R, Fiore MC, et al. Implementing Clinical Research Using Factorial Designs: A Primer. Behav Ther. 2017 Jul;48(4):567-580. doi: 10.1016/j.beth.2016.12.005.

Piper ME, Cook JW, Schlam TR, et al. Toward precision smoking cessation treatment II: Proximal effects of smoking cessation intervention components on putative mechanisms of action. Drug Alcohol Depend. 2017;171:50–58. doi:10.1016/j.drugalcdep.2016.11.027.

Piper ME, Fiore MC, Smith SS, et al. Identifying effective intervention components for smoking cessation: a factorial screening experiment. Addiction. 2016;111(1):129–141. doi:10.1111/add.13162.

Schlam TR, Fiore MC, Smith SS, et al. Comparative effectiveness of intervention components for producing long-term abstinence from smoking: a factorial screening experiment. Addiction. 2016;111(1):142–155. doi:10.1111/add.13153.

Baker TB, Collins LM, Mermelstein R, et al. Enhancing the effectiveness of smoking treatment research: conceptual bases and progress. Addiction. 2016;111(1):107–116. doi:10.1111/add.13154.

Find more peer-reviewed articles supported by this grant on this PubMed list.