Project 4: Longitudinal Care; smoking reduction to aid cessation

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Background. More than 75% of smokers report that they would like to quit but each year less than 10% successfully achieve long-term abstinence each year. The chronic nature of tobacco dependence has been compared to other medical disorders such as diabetes, however current models of care for smokers do not incorporate principles of chronic disease management. Objective. The obj ective of this project is to conduct a randomized controlled trial to compare 1) a longitudinal care smoking cessation treatment delivered over a one-year period (LC) to 2) discrete episodic smoking cessation treatment (DC) to determine ifLC improves prolonged smoking abstinence. Methods. 440 smokers who are interested in quitting will be enrolled and randomly assigned to the LC or DC groups. Both groups will initially receive a state-of-the-science smoking cessation intervention including behavioral and pharmacological components, delivered by a combination of in-person and telephone care. LC participants who fail to quit, reduce but do not quit, or relapse will receive intensive treatment over the ensuing 12 months that encourages repeat quit attempts and smoking reduction if they are not ready to quit. We propose reduction as an intermediate goal in LC because this may increase the likelihood of cessation, increase self-efficacy and keep smokers and clinicians engaged. Reduction treatment will include behavioral treatment and nicotine replacement. DC participants will only receive occasional prompts to quit. The primary endpoint will be 6M of abstinence measured 18M after enrollment. Secondary endpoints will include point prevalent abstinence, smoking reduction, self-efficacy and satisfaction. We will also collect qualitative data from successful abstainers and reducers about decision making processes and intervention experiences. Significance. This project will address the potential role of smoking reduction in the treatment menu for smokers interested in quitting. This project, together with the Dr. Hatsukami and Dr. Pentel's proposals, examine mechanisms, methods and a "real world" application for reducing toxin exposure.