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Section 9
Counselor Impact on Smoking Cessation Strategy Effectiveness

Question 9 | Test | Table of Contents

There is much research on the smoking cessation process for adults. Self-help versus counselor-assisted approaches, behavioral versus cognitive strategies, and emotional versus environmental factors have been explored and analyzed in the counseling literature. Zelman, Brandon, Jorenby, and Baker (1992) compared the success of groups in four combinations of counselor-assisted methods, including (a) skills training, [b) support counseling, (c) nicotine gum, and (d) rapid smoking (see Appendix for italicized terms). All four groups reported high initial smoking cessation rates (84% average), with supportive counseling being more effective initially with smokers high in negative affect (emotional distress). Skills training was more helpful at first for those with low negative affect. Rapid smoking helped smokers who use cigarettes as positive reinforcement, whereas the nicotine gum helped those who smoke to alleviate withdrawal. Zelman et al. concluded that counselors should wait until high negative affect clients are past the withdrawal stage before introducing skills training. The 12 month follow-up showed a still respectable 28% to 40% success rate. Combinations of nicotine gum with skills training and nicotine gum with support counseling yielded the highest success rates of 40% and 39%, respectively.

Glasgow, Schafer, and O'Neill (1981) assessed whether it is more effective to use self-help methods or to stop smoking with the assistance of a counselor. The results were mixed. When participants were given a 90- or 154-page book to read to help them stop smoking, most did not stop smoking or even read the materials unless they were also seeing a counselor. Participants were most successful at quitting; however, when given a 20-page, easy-to-read booklet and with no counselor assistance. This result contrasted with many other studies in this review, which indicated that counselor assistance increased success rates.

Orleans et al. (1991) also evaluated the benefits of counselor-assisted smoking cessation attempts, but the assistance was conducted by telephone. Counselor contact boosted quit rates in this study by 50%, causing participants to more closely follow steps outlined in various self-help guides they were given. Successful quitters had more social support, were highly motivated to quit, and had moderate self-efficacy ratings. Quitters used more pre-quitting strategies but not more quitting methods. In fact, Orleans et al. found that those using more than one of the self-help stop-smoking guides were less likely to successfully stop smoking.

Zhu, Tedeschi, Anderson, and Pierce (1996) compared results of a telephone counseling protocol with those of a self-help group. These researchers found many benefits from telephone counseling compared with persuading participants to use a stop-smoking group program. The anonymous nature of a phone call as well as the individualized approach encouraged participants to be more open and to have more specific needs met. Counselors initiated phone calls, so they did not have to wait for participants to call or worry about dropouts. The focus of the counseling was on boosting motivation and self-efficacy as well as developing coping skills. The counselor would assess the smoker's current smoking behavior and history of quitting and then assist him or her in developing a plan to stop smoking. Zhu et al. discovered that participants receiving the most counselor contact had the highest rates of success, indicating a clear "dose-response" relationship; that is, increased application of the dose (counselor contact) was strongly and positively correlated with the response (participants' smoking cessation). At 12 months, participants using self-help materials experienced a 15% success rate. Even one phone call from a counselor boosted that rate to 20%. Of those receiving multiple calls, 27% were nonsmokers at 1-year postcessation. (Percentages are rounded.)

Effective strategies for adult cessation have been well documented. Having strong motivation (Glasgow, Klesges, Mizes, & Pechacek, 1985), social support (Mermelstein, Cohen, Lichtenstein, Baer, & Kamarck, 1986; Orleans et al., 1991), and high-perceived self-efficacy (Condiotte & Lichtenstein, 1981; Orleans et al., 1991; Zhu et al., 1996) are factors commonly associated with successful adult smoking cessation. Adults are more likely to choose cognitive strategies and find them easier to use than behavioral strategies (Glasgow et al., 1985). Contact with a counselor improves chances of success, even when contact is brief (Condiotte & Lichtenstein, 1981; Glasgow et al., 1981; Orleans et al., 1991) and when the counselor has little knowledge of how to help someone stop smoking (Jenks, Schwartz, & Dubitzky, 1969).

Adults can benefit from smoking cessation strategies that address the issues that constitute their reasons for smoking. Support from people in a smoker's life, including that of a counselor, can help a smoker develop and sustain the motivation and confidence to successfully stop smoking.
- Singleton, Mary G and Mark Pope; A Comparison of Successful Smoking Cessation Interventions for Adults and Adolescents; Journal of Counseling & Development; Fall 2000; Vol. 78 Issue 4

Personal Reflection Exercise #2
The preceding section contained information about counselor impact on smoking cessation strategy effectiveness.  Write three case study examples regarding how you might use the content of this section in your practice.
Reviewed 2023

Update
The effectiveness of smoking cessation interventions
in rural and remote populations: Systematic review and meta-analyses

- Vance, L., Glanville, B., Ramkumar, K., Chambers, J., & Tzelepis, F. (2022). The effectiveness of smoking cessation interventions in rural and remote populations: Systematic review and meta-analyses. The International journal on drug policy, 106, 103775. https://doi.org/10.1016/j.drugpo.2022.103775


Peer-Reviewed Journal Article References:
Kurti, A. N. (2020). Reducing tobacco use among women of childbearing age: Contributions of tobacco regulatory science and tobacco control. Experimental and Clinical Psychopharmacology, 28(5), 501–516.

Palmer, A. M., & Brandon, T. H. (2018). How do electronic cigarettes affect cravings to smoke or vape? Parsing the influences of nicotine and expectancies using the balanced-placebo design. Journal of Consulting and Clinical Psychology, 86(5), 486–491.

Pedersen, E. R., Tucker, J. S., Davis, J. P., Dunbar, M. S., Seelam, R., Rodriguez, A., & D'Amico, E. J. (2020). Tobacco/nicotine and marijuana co-use motives in young adults: Associations with substance use behaviors one year later. Psychology of Addictive Behaviors. Advance online publication.

QUESTION 9
According to Singleton, what are three important factors associated with successful adult smoking cessation? To select and enter your answer go to Test.

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