DESCRIPTION: The proposed research is designed to develop and evaluate
efficacious and cost-effective combinations of behavioral interventions and
Nicotine Replacement Therapy (NRT) for smoking cessation. NRT has been
demonstrated to be effective but has been used by only a small percentage of
the smokers. In contrast, population based interventions with proactive
recruitment and stage matched interventions have the potential to reach more
than 80 percent of the population. The proposed research will combine NRT
with two recently developed, highly effective behavioral interventions that
employ digital technology to produce individualized, low cost interventions.
These interventions have the potential to both increase the proportion of
smokers who receive NRT and the effectiveness or NRT. Expert System
interventions based on the Transtheoretical Model have demonstrated
effectiveness in two population-based studies without NRT.
Telecommunications represents a low cost method of providing high frequency
always available automated counseling services to smokers. The proposed
study is a population based clinical trial with 2200 smokers proactively
recruited from a large VA system and randomly assigned to one of four
conditions, varying from minimal intervention to high intensity. The
conditions include: (1) Minimal Intervention, which involves only
stage-matched manuals; (2) NRT Alone, which provides NRT with only manuals;
(3) Expert System, which combines NRT, the Expert System and Manuals; and
(4) Telecommunications, which combines the previous interventions with an
automated telephone counseling intervention. In the three NRT conditions,
NRT will be provided only to those smokers for whom it is appropriate. A
goal of the behavioral interventions is to increase the proportion of the
smokers who receive NRT. Data analysis will identify the most efficacious
interventions in preparation for dissemination to entire population. Stage
matched, interactive, and proactive interventions that match behavioral and
pharmacological elements to the individual smoker have the potential to
produce unprecedented impacts on an entire population of smokers.
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