Intervention Summary

Study 1

Severson, H. H., Andrews, J. A., Lichtenstein, E., Danaher, B. G., & Akers, L. Self-help cessation programs for smokeless tobacco users: Long-term follow-up of a randomized trial. Nicotine and Tobacco Research, 9(2), 281-289.  

Severson, H. H., Andrews, J. A., Lichtenstein, E., Gordon, J. S., Barckley, M., & Akers, L. A self-help cessation program for smokeless tobacco users: Comparison of two interventions. Nicotine and Tobacco Research, 2(4), 363-370.  

Study 2

Cigrang, J. A., Severson, H. H., & Peterson, A. L. Pilot evaluation of a population-based health intervention for reducing use of smokeless tobacco. Nicotine and Tobacco Research, 4(1), 127-131.  

Study 3

Severson, H. H., Peterson, A. L., Andrews, J. A., Gordon, J. S., Cigrang, J. A., Danaher, B. G., et al. Smokeless tobacco cessation in military personnel: A randomized controlled trial. Nicotine and Tobacco Research, 11(6), 730-738.  

Study Strengths

The measures used to assess self-reported abstinence from all tobacco use are standard and have been shown to have adequate reliability and validity by other investigators. There is face validity for attempts to quit smokeless tobacco use and for use of recommended cessation techniques. There is little opportunity for variability in the implementation of the mailed guide and DVD. In one study, almost all participants reported that they read the guide, and most participants in the intervention group reported that they watched the DVD. In another study, tobacco cessation counselors received training, used written prompt sheets, and received weekly feedback from one of the investigators, and calls by counselors were recorded and reviewed by a supervising psychologist. In one study, there was no difference in attrition rate between intervention and comparison groups, and in another study, the attrition rate was low. All studies used a conservative intent-to-treat model as a method to manage missing data. Randomization of participants to the study conditions minimized confounding variables. In two of the studies, sample sizes were large and provided adequate power. Data analyses were appropriate for all three studies.

Study Weaknesses

The reliability of measures for attempts to quit smokeless tobacco use and use of recommended cessation techniques was not addressed. In two of the studies, there was no monitoring or measurement of fidelity of the supportive phone calls and very limited discussion of the nature of the training received by the counselors. In one study, the percentage of participants who read the guide or watched the DVD at least once was not reported. Although phone calls were reviewed by a supervisor in one study, there was no fidelity check on adherence to the basic elements of the intervention and no report of the types of fidelity problems encountered or how often interviewers were counseled for not following protocol. In two studies, there was considerable attrition across the assessments; there also were a few differences between study completers and dropouts, especially in one of the studies, where there were differences in potential confounding variables such as current smoking, attempts to quit, and use of smokeless tobacco. Also in this study, although it is reasonable to expect that participants in the intervention and control groups had a similar health status and attitudes, these potential confounding variables were not mentioned or controlled for. The sample size for one study was small and may not have been adequate for detecting significant between-group differences.