Smoking is the number one health problem faced by the world today. Computers have increasingly been evaluated as a method to deliver smoking cessation self-help messages. Individually tailored printed reports generated by computers have been effective at encouraging smokers at various levels of motivation to change. The programs studied are limited in two areas: 1) the systems studied in controlled trials are primarily limited to a self-help approach and have not been integrated into physician-patient interactions and 2) previous systems have not taken full advantage of the accessibility and interactivity made available through the Internet revolution. A large body of evidence substantiates the effectiveness of physician counseling, an underutilized intervention, on smoking cessation. One paradigm that has been proven to be successful for other medical conditions but has not been applied to expert systems for smoking cessation is the model of pre-visit coaching. "Patient activation" as it is known has the capacity to encourage patients to ask questions and seek physician advice. AIM 1. To explore potential methods of incorporating concepts of patient activation and social networking into an existing evidence-based primary care smoking cessation computer program to: 1) provide individual assessment and tailored feedback to encourage cessation; 2) coach patients about how to talk with their physician about smoking cessation; and 3) help users enlist the support of others around them as they try to quit smoking. AIM 2. To design and implement an Internet-based smoking cessation system (Smoking Cessation Coach) based on concepts identified and refined in AIM 1. AIM 3. To complete a series of three small pilot studies to: 1) explore patient provider interaction after an individual completes the Smoking Cessation Coach; 2) explore what the characteristics of smokers who do and do not actually access the site with the Smoking Cessation Coach after being informed of the program at a primary care office; and 3) measure the prevalence of use and perceived value of the Smoking Cessation Coach after four weeks of follow-up among a cohort of individuals recruited from the Internet. At the completion of the two years for this grant we will have developed and completed pilot testing of an internet-based smoking cessation program that will build on the skills of physicians and others who interact with the individual trying to stop smoking on a daily basis. Such a program has a high potential of reaching a large number of smokers. The plan will be to evaluate the cost-effectiveness of the Smoking Cessation Coach in the next study.
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