Cue-based treatment for light smokers: A proof of concept pilot.


INTRODUCTION:Light smoking (smoking ≤ 10 cigarettes per day or on some days) has become increasingly prevalent in the US and increases morbidity and mortality. Many light smokers do not experience significant nicotine withdrawal but instead smoke in response to cues. Minimal evidence exists supporting interventions to help light smokers quit smoking. METHODS:We present results from a proof-of-concept pilot study designed to evaluate the feasibility and acceptability of a cue-based smoking cessation intervention targeted to light daily and intermittent smokers. Participants were randomized to one of two arms: Arm 1) standard smoking cessation treatment or Arm 2) standard smoking cessation treatment + enhanced cue-based treatment that included interactive texting to extend cue exposure treatment to real-world settings and cue management counseling.Outcomes included feasibility (number of participants who were recruited and who completed the intervention), acceptability (intervention ratings), and preliminary efficacy (7-day point prevalence abstinence). RESULTS:We randomized 24 English and Spanish-speaking light smokers, 13 to the treatment arm and 11 to the control arm. Across both arms, 77% attended all counseling sessions, 90% rated these sessions as very useful and 100% said that they would recommend the intervention to a friend. 15% in the treatment arm had biochemically-validated smoking abstinence compared to 0% in the standard counseling arm. CONCLUSIONS:Results from this proof-of-concept study demonstrated that a cue-based intervention is feasible and acceptable among light smokers and suggests the need for a fully powered study to assess this approach. TRIAL REGISTRATION:This study is registered at NCT03416621.






Published Version (Please cite this version)


Publication Info

Pollak, Kathryn I, Jason A Oliver, Carl Pieper, James M Davis, Xiaomei Gao, Devon Noonan, Danielle Kennedy, Isa Granados, et al. (2020). Cue-based treatment for light smokers: A proof of concept pilot. Addictive behaviors. p. 106717. 10.1016/j.addbeh.2020.106717 Retrieved from

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.



Kathryn IIonka Pollak

Professor in Population Health Sciences

Dr. Pollak is a social psychologist who designs and tests behavioral interventions to promote smoking cessation, reduce health disparities, and improve clinician-patient communication. She also is one of the Multiple Principal Investigators of the Palliative Care Research Cooperative that supports multi-site palliative care trials. Finally, Dr. Pollak serves as a Communication Coach where she teaches clinicians effective communication techniques.

Area of expertise: Health Behavior


Jason A Oliver

Adjunct Assistant Professor in the Department of Psychiatry and Behavioral Sciences

Dr. Oliver is a clinical psychologist by training and is currently pursuing licensure in North Carolina. He received his graduate degree from the University of South Florida and completed his doctoral internship at Yale University School of Medicine. His research focuses on understanding of addictive behaviors, with a particular emphasis on tobacco use. His research program is heavily translational and includes both basic and clinical components. He has experience conducting human laboratory research, clinical trials and policy research. Long-term, he aims to identify new neural and behavioral markers for addiction that can serve as targets for novel interventions. 


Carl F. Pieper

Professor of Biostatistics & Bioinformatics

Analytic Interests.

1) Issues in the Design of Medical Experiments: I explore the use of reliability/generalizability models in experimental design. In addition to incorporation of reliability, I study powering longitudinal trials with multiple outcomes and substantial missing data using Mixed models.

2) Issues in the Analysis of Repeated Measures Designs & Longitudinal Data: Use of Hierarchical Linear Models (HLM) or Mixed Models in modeling trajectories of multiple variables over time (e.g., physical and cognitive functioning and Blood Pressure). My current work involves methodologies in simultaneous estimation of trajectories for multiple variables within and between domains, modeling co-occuring change.

Areas of Substantive interest: (1) Experimental design and analysis in gerontology and geriatrics, and psychiatry,
(2) Multivariate repeated measures designs,


James Davis

Associate Professor of Medicine

Dr. James Davis is a practicing physician of Internal Medicine, and serves as the Medical Director for Duke Center for Smoking Cessation, Director of the Duke Smoking Cessation Program and Co-Director of the Duke-UNC Tobacco Treatment Specialist Credentialing Program.  His research focuses on development of new pharmaceutical treatments for smoking cessation.  He is principal investigator on several trials including a study on “adaptive” smoking cessation and several trials on new medications for smoking cessation. The new medications leverage more novel neurobiological mechanisms - NMDA receptor antagonism, nicotinic receptor antagonism, which impact addiction-based learning and cue response. Additionally, Dr. Davis serves as co-investigator on trials on lung cancer screening, e-cigarettes, minor nicotine alkaloids, imaging trials, lung function trials and others. Dr. Davis leads the Duke Smoke-Free Policy Initiative, is co-author on a national  tobacco dependence treatment guideline, and provides training in tobacco dependence treatment for the Duke School of Medicine, Duke Internal Medicine, Family Practice and Psychiatry residency programs.


Devon Noonan

Associate Professor in the School of Nursing

Dr. Noonan is a nurse scientist, certified addictions nurse and an Associate Professor in the Duke School of Nursing. She received her BSN at Boston College, her MS in Nursing at Georgetown University, her MPH and PhD at the University of Virginia and completed a Post-Doctoral Fellowship at the University of Michigan. Dr. Noonan’s research is focused on using community-engaged approaches to develop innovative health behavior change interventions, including digital interventions, with the goal of reducing risk for chronic diseases including cancer and cardiovascular disease. Dr. Noonan’s work has a strong focus on rural and medically underserved populations. Much of her work also focuses on tobacco cessation. She has been continuously funded by NCI for the past 5 years to examine text-based intervention approaches for tobacco cessation in rural and medically underserved populations. Dr. Noonan teaches and mentors students across all programs at DUSON and is the Co-Director of the Duke National Clinician Scholars Program.


Isa Granados


Isa Granados is currently pursuing her Ph.D. in Population Health Sciences at Duke University School of Medicine. Isa's academic journey began at the University of North Carolina at Chapel Hill, where she graduated with a double major in Psychology and Global Studies and a minor in History.

Isa's commitment to improving health outcomes among children and adults with obesity and chronic diseases is evident throughout her career. Her career commenced as a Health Education Specialist at FirstHealth of the Carolinas, where she implemented evidence-based programs addressing childhood obesity, type 2 diabetes, chronic diseases, and smoking cessation. As the sole bilingual health educator, Isa played a pivotal role in expanding health program accessibility to Spanish-speaking communities.

Currently in her third year of the Ph.D. program, Isa's research, funded by the NICHD Diversity Supplement, focuses on creating an evidence base for the effective sustainability of a pediatric obesity intervention to reduce health disparities. Her expertise extends to various research projects and collaborations, including roles as a Graduate Research Assistant at the Durham VA Center of Innovation, Duke University, and the Duke Center for Child Obesity Research.

As a Public Policy Fellow at AcademyHealth, Isa collaborates with the Director of Advocacy, advancing the organization's mission through advocacy, public policy, education, and policy communication. Her responsibilities include drafting and editing research memos, tracking legislation, and effectively communicating with federal policymakers.

Isa is actively engaged in community service and professional development. She is a member of the Partnership for a Healthy Durham in the Physical Activity, Nutrition, and Food Access Committee, and she previously led the Durham NCCARE360 Advisory Council. Isa also contributes to diversity and inclusion efforts as a member of the DEI Committee in Duke's Population Health Sciences Department, serving on the Faculty and Staff Diversity Committee. Additionally, she is a dedicated member of Latinx Advocacy Teams and Interdisciplinary Network for COVID-19 (LATIN-19).


Laura Jane Fish

Assistant Professor in Family Medicine and Community Health

Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.