Behavioral activation for smoking cessation and the prevention of smoking cessation-related weight gain: A randomized trial

Background: Post-cessation weight gain (PCWG) is an obstacle to smoking cessation. This trial evaluated a behavioral intervention targeting alternative rewards to smoking and high calorie snacking to promote smoking cessation while mitigating PCWG.Methods: Adult smokers (n = 288; 119 females, 169 males) received eight weeks of transdermal nicotine and were randomized to eight sessions of behavioral activation for smoking cessation and the mitigation of PCWG (BAS+) or standard smoking cessation counseling (SC). Primary outcomes were 7-day point prevalence absti-nence and PCWG 26 weeks after the target quit date. Change in caloric intake from pre-treatment through the 26 -week follow-up was a secondary outcome. Data were collected from September 2016 to February 2021, and analyses were completed in July 2022. Results: BAS+ and SC did not differ in smoking abstinence rates at the 26-week follow-up (OR=0.80, 95%CI 0.50-1.27, p = 0.34; 18% versus 23%). There were no significant differences in PCWG between BAS+ and SC who were 7-day point prevalence abstinent (beta =-0.29, 95%CI-2.13 to 1.65, p = 0.77; 2.60 versus 2.20 pounds, respectively) or among those continuously abstinent (5.78 versus 5.34 pounds, respectively). There were no significant differences in caloric intake between BAS+ and SC from baseline to the 26-week follow-up (beta = 110.65, 95%CI-96.72 to 318.02, p = 0.30;-19.1 versus-116.9 kcals/day, respectively).Conclusions: The results do not support the efficacy of BAS+ for smoking cessation and the prevention of PCWG. These findings join a growing body of research highlighting the challenge of minimizing PCWG and promoting smoking abstinence.