TREATMENT AND MECHANICAL COMPLIANCE IN A MULTICOMPONENT SMOKING CESSATION PROGRAM (BEHAVIORIAL, SELF-MANAGEMENT, TOBACCO)

Evaluations of the effectiveness of smoking cessation treatment programs have generally omitted information regarding compliance with behavioral prescriptions. The purpose of the present study was to document compliance, and then demonstrate its relationship to smoking reduction. A multicomponent behavioral program had three periods: Baseline week, Reduction (weeks 2-4), and Post Quit Date (weeks 5-7). Compliance was divided into two parts. Treatment compliance was defined as the emission of coping skills after an urge to smoke. Mechanical compliance was adherence to administrative aspects of the program independent of performance of coping skills (attendance, completion of self-monitoring forms, and the like).^ From 45 members of health maintenance organization who began treatment, records of urges and use of coping skills were collected (from 35 in Reduction and 26 in Post Quit Date). Smoking levels were significantly reduced. The greater average treatment compliance overall treatment (weeks 2-7), the greater reduction from baseline smoking (r(22) = -.61, p \u3c .01). Average treatment compliance within Reduction did not predict average change from baseline smoking within Reduction, but Post Quit Date treatment compliance predicted Post Quit Date change from Baseline smoking (r(22) = -.78, p \u3c .01). Mechanical compliance overall treatment did not predict change from baseline smoking. Use of cognitive coping skills was found to be more effective in smoking reduction than behavioral skills.^ Pleasure and Loss Hierarchies constructed using paired comparison methods yielded outcome information. The more subjects endorsed smoking as a pleasure at treatment\u27s end, the less their final smoking reduction, the less their mechanical compliance, and the less their cognitive skill usage.^ It was concluded that for the positive effects of coping skills treatment to be seen it is necessary to monitor compliance beyond the period in which nonspecific treatment effects are also potent. It was concluded that outcome studies not presenting compliance data represent worst case estimates since they confound treatment failures with failure to follow behavioral prescriptions. Subjects who participate in a smoking cessation program but do not reduce their smoking behavior may continue to smoke to maintain their pleasure from smoking.