Not every smoker who comes into a primary-care clinic is going to want to quit, but many are open to cutting down. UW-CTRI’s primary research study, Breaking Addiction to Tobacco for Health (BREATHE), has a project designed specifically to motivate patients who aren’t ready to quit smoking but are open to reducing it. BREATHE Project 2 (part of the NCI-funded UW-CTRI P01 grant), led by UW-CTRI Researcher Dr. Jessica Cook (left), tests four different intervention components to see which best helps smokers who are not yet ready to quit: 

  1. Behavioral Reduction Counseling. In this treatment, BREATHE counselors work with study participants to learn strategies, like delaying having a cigarette, which can help them gain control of their smoking. While practicing these new strategies, participants work with their counselor toward a goal of cutting their smoking in half.
  2. Behavioral Activation Counseling. This treatment encourages participants to engage more frequently in important parts of their lives. The idea behind this treatment is that increasing engagement in pleasurable or meaningful activities that are incompatible with smoking might make it easier to cut down and to even quit someday. For example, a patient may find that exercising, spending more quality time with family, or increasing meaningful engagement in hobbies might make it easier to cut down.
  3. 5Rs Motivation Counseling. This treatment helps participants think about the Reasons, Risks, Rewards, and Roadblocks of cutting down on their smoking. This discussion is Repeated during a 1-year period.
  4. Nicotine mini-lozenges.

BREATHE Project 2 tests each of the four treatments by themselves or in any combination with the others, for a total of 16 different combinations. This is called a factorial design. Researchers hope to learn whether cutting down on smoking reduces nicotine dependence or withdrawal symptoms, and thereby makes it easier to quit smoking entirely. 

It is also possible that cutting down will boost smokers’ self-confidence in their ability to quit. This could increase the likelihood of eventually making a quit attempt.

Patients will participate in Project 2 for about one year, and the project will run throughout the life cycle of the BREATHE study as new patients are recruited. An over-arching goal of BREATHE is to establish a highly effective treatment for all smokers, regardless of readiness to quit, one that can be implemented in any primary-care setting.