DESCRIPTION (provided by applicant): Virtually all smoking cessation interventions have been conducted on smokers who indicate a willingness to quit smoking. Much less well-studied are approaches for assisting smokers who are not ready to quit smoking at the current time (ex., not in the next 30 days). The paucity of research on smokers not ready to quit smoking is present despite the fact that the majority of smokers are not ready to quit smoking at any given point in time. While almost 69% of smokers want to quit at some time in the future, fewer than 10% of smokers are ready to make a serious smoking cessation attempt in the next 30 days. There have been two different approaches towards increasing cessation rates in smokers not ready to quit (SNRTQ). The first approach Motivational Interviewing (MI) using "5Rs"as a foundation (Relevance, Risks, Rewards, Roadblocks, Repetition). However, only one study, which is a decade old, has evaluated the impact of MI with SNRTQ - with MI producing both higher quit attempts and smoking cessation than a) reduction counseling using nicotine replacement therapy plus brief advice alone and b) no treatment. The second approach combined behavioral/pharmacological rate reduction as an approach to produce reductions in tobacco use as well as to enhance self-efficacy for smoking cessation Combined behavioral/pharmacologic rate reduction has been shown to more than double the odds of cessation in SNRTQ. To our knowledge, no study has evaluated the independent effects of MI and Rate Reduction, individually versus in combination, for motivating SNRTQ to increase both quit attempts and tobacco abstinence. Thus, we propose the following Specific Aims: (1) To test a tobacco Quit Line for SNRTQ; (2) To randomize 2100 SNRTQs to: (a) Brief Advice + typical smoking cessation resources (control group); (b) Motivational Interviewing using the 5Rs (MI/5Rs) format recommended by the Clinical Practice Guidelines; (c) Combined behavioral and pharmacologic Rate Reduction, and (d) both MI/5Rs + combined behavioral and pharmacologic Rate Reduction. This design allows us to evaluate the independent and additive effects of MI and Rate Reduction on quit attempts and smoking cessation; (3) to evaluate the efficacy of the intervention. The primary endpoint will be point prevalence at the 6-month post-intervention follow-up (12 months after randomization). Prolonged abstinence at the 6-month post intervention follow-up and quit attempts at the 2-, 4- and 6-month and the 6-month post intervention follow-up are secondary endpoints, and; (4) To determine the cost effectiveness (cost per quit smoker) of each of the interventions. The current proposal addresses the underserved population of SNRTQ is highly significant, innovative, and has a tremendous public health impact.
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