4. Discussion
SECONDARY
The purpose of this study was to identify interpersonal and intervention use characteristics associated with re-engagement among adults participating in a quit line intervention study. To our knowledge, this study is the first to consider personal, tobacco use, motivation, and initial intervention utilization factors that may be associated with re-engagement in a quit line intervention. We found that, among all possible characteristics of interest, non-White race and high levels of baseline confidence in quitting were associated with re-engagement at three months. Engagement with the initial intervention was also associated with re-engagement, specifically the number of initial counseling sessions completed. These results provide new information about why some adults who smoke who fail to quit may ultimately choose to re-engage in a quit line intervention, establishing new potential directions for future studies.Some studies have attempted to increase re-engagement in quit line services among adults who smoke who initially fail to quit. For example, Vickerman et al. randomized callers to the Minnesota Quit Line into receiving or not receiving re-engagement outreach [We also identified previously unconsidered motivational factors that were associated with re-engagement at three months. Specifically, participants with higher levels of baseline confidence in quitting were more likely to re-engage at three months, which was roughly 6 weeks after the initial intervention ended. It is noteworthy that baseline confidence would produce such an effect, especially within a sample of adults who were all unsuccessful in their first quit attempt. It is possible that increasing confidence in quitting by providing motivational messages by counselors early in quit line counseling may increase their engagement in the initial intervention as well as the likelihood that those still smoking after their initial quit attempt will subsequently be open to re-engagement. Tangentially, Danaher et al. found that positive changes in ratings on a five-point Likert scale of one’s confidence of being tobacco-free in 1 year mediated the relationship between a web-based tobacco intervention and abstinence at 3- and 6-month follow-up [Our finding that participants who completed more initial intervention quit line counseling sessions had increased odds of re-engagement with the quit line intervention suggests that increasing initial intervention engagement could be a promising strategy to maximize re-engagement following an unsuccessful quit attempt. To our knowledge, no studies have sought to bolster initial engagement of quit line callers with the goal of improving chances of eventual re-engagement intervention. Beebe et al. (2020) found that selection of a less intensive option by callers for their initial intervention predicted increased likelihood of re-engagement [This study estimated the effect of initial intervention engagement on re-engagement at three months independent of baseline motivational factors such as confidence in quitting some day and specific reasons for quitting smoking, including quitting to be a good role model and quitting to control one’s life. Nevertheless, there remains a potential that motivation has an influence on both initial intervention engagement and interest in re-engagement after relapse. Due to missing data at three months, we were not able to consider motivational items at the time of re-engagement. However, descriptively at three months, a higher percentage of participants who chose to re-engage reported seeing extreme benefit in quitting for their health (65.6% vs. 49.3% for re-engaged and non-re-engaged, respectively, This study has several limitations that need to be considered. First, these results are from a secondary analysis of data from a randomized trial [