A UW-CTRI paper used a sophisticated analytic approach to determine a set of baseline predictors for treatment outcomes in the BREATHE 1 Motivation Study led by Dr. Jessica Cook. The primary study found that some treatment components yielded unintended adverse clinical outcomes. This new paper sought to explain these effects.
The results, published in Addictive Behaviors, found that the key predictor of clinical outcomes in patients not ready to quit was their own belief about whether they would succeed at quitting smoking.
The treatment components that yielded unintended adverse effects only did so in those with low cessation self-efficacy. Specifically, “smoking reduction counseling” reduced the odds of a quit attempt. Additionally, nicotine mini-lozenges reduced the odds of entering cessation treatment.
Lead author and UW-CTRI Researcher Dr. Jen Betts and her co-authors concluded that, for participants with low self-efficacy, asking them to cut their smoking in half was perhaps too high a bar.
“Our hypothesis is that participants with low cessation self-efficacy may have perceived the goal of reducing their smoking by half as too difficult,” Betts said, “and that actually reduces their motivation to make changes to their smoking.
“We know that people need to perceive goals as attainable and appropriate in order to feel motivated to work for them.” Otherwise, they feel defeated.
“So, in the future, reduction goals should be guided by what participants are willing to do – goals they see as reasonable and attainable.”
Betts said it’s possible that, for those who have struggled to quit in the past, that they are sensitive to struggling again during a study like this. Therefore, if they do struggle, their motivation to make changes decreases.
Researchers were able to determine that cessation self-efficacy was the most important predictor of outcomes, over other factors like negative mood.
While reduction counseling and nicotine mini-lozenges seemed counter-productive for people who had little faith they could quit, the authors suggested that varenicline might have a better shot at lifting their belief.
“Varenicline has shown in a few studies so far that it might be a helpful treatment for those not yet ready to quit, but we don’t know how it directly compared to nicotine replacement therapy for such individuals,” Betts said. “So, if there are better effects of varenicline on craving and withdrawal suppression, that might help achieve abstinence and might be particularly helpful for those with low cessation self-efficacy who perhaps were not as successful in this study with reduction counseling or mini-lozenges.”
Betts JM, Klemperer EM, Baker TB, Loh WY, Coleman SRM, Cook JW. Treating Those Not Ready to Quit Smoking: Doing Harm While Trying to Help? Addictive Behaviors. 176. Online February 3, 2026.