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Results of a feasibility study of Helpers Stay Quit Training for smoking relapse prevention.

INTRODUCTION
Most smoking quit attempts end in relapse, and interventions focused on relapse prevention are lacking. Helpers Stay Quit (HSQ) is a novel behavioral relapse prevention intervention that teaches newly abstinent smokers to offer a "helping conversation" (HC) to help others quit tobacco.


METHODS
Pre-post intervention feasibility study with state quitline participants ≥ 14 days abstinent. Measures at baseline, 3- and 6 months included: smoking status, offering of HCs, and cessation self-efficacy. Primary outcomes: self-reported 7-day point prevalence abstinence; offering HCs. Cox models explored association of HCs with relapse. Preliminary effects analysis using propensity score matching compared 30-day abstinence of quitline clients with study sample at 7-months.


RESULTS
Participants (N=104) were: mean age of 53 years (SD 13.9 years), 48.1% male, mean of cigarettes smoked/day of 16.2 (SD 9.7). Compared to participants who remained abstinent (n=82), relapsers (n=22) had fewer HCs over 6 months (2.6 vs. 7.2 (95%CI: 1.4, 7.8, p = 0.006). Using adjusted Cox regression, the hazard ratio of relapse for each HC was 0.85 (95%CI: 0.74, 0.99, p = 0.03). Compared to a matched sample of quitline clients not exposed to HSQ, study participants were 49% more likely to report 30-day abstinence at 7-month quitline follow-up (95% CI: 40%, 59%, p<0.0001).


CONCLUSIONS
HSQ, delivered to newly abstinent smokers who received standard quitline treatment, was associated with less self-reported relapse. These promising preliminary study results warrant further research to evaluate HSQ as a novel behavioral intervention to prevent smoking relapse.


IMPLICATIONS
To date, behavioral interventions for smoking relapse prevention that teach abstainers cessation skills to apply to themselves have not shown effectiveness. This feasibility study examines the preliminary efficacy of a conceptually novel, "help others" behavioral intervention approach for relapse prevention in newly abstinent smokers recruited from a state quitline. Helpers Stay Quit teaches the newly abstinent smoker communication and listening skills to encourage other smokers in their personal social network to quit. Exploratory analysis using propensity score matching suggest that participants exposed to HSQ were significantly more likely to self-report 30-day abstinence at quitline 7-month follow-up than other quitline clients.