Testing Intervention Components for the Smoker who is Unwilling to Quit

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Cigarette smoking is the leading preventable cause of cancer and accounts for over $96 billion in annual direct medical costs in the US. To reduce the enormous health and economic harms of smoking, we need a comprehensive approach to engage all smokers visiting healthcare settings in treatment that efficiently and effectively helps them stop smoking. Unfortunately, most smokers making a healthcare visit are unwilling to make a serious quit attempt, and there are few empirically validated treatments to motivate them to quit and prepare them to quit successfully. In sum, we do not know which intervention components are optimal for smokers unwilling to quit¿a group that comprises the majority of smokers at any point in time. Project 2 aims to identify highly effective intervention components for smokers initially unwilling to quit. Smokers (N=512) making routine healthcare visits to primary care clinics who are unwilling to quit will be identified and recruited using an enhanced Electronic Health Record (EHR). Consistent with the Multiphase Optimization Strategy (MOST), we will use a highly efficient factorial design (2x2x2x2) to test four different intervention components: 1) Type of Nicotine Replacement (Nicotine Gum vs. Nicotine Mini-Lozenge), 2) Behavioral Reduction Counseling (off/on), 3) SRs Motivation Counseling (off/on), and 4) Behavioral Activation Counseling (off/on). These components have strong theoretical and empirical support, but their relative, additive, and interactive effects are unknown. The most promising of these components will be integrated with additional components tested in the other projects in this P01 to form a chronic care treatment that provides effective treatment for all phases of smoking intervention: from motivating quitting to recovering from relapse. Project 2 is linked to other projects in this P01 with a planned interiocking design: as participants express readiness to quit in Project 2, they will receive the Cost-Optimized Cessation treatment in Project 3. Thus, not only will we identify intervention components that produce the greatest smoking reduction and quit attempts, we will also identify which components help smokers benefit from the next element in a chronic care model for smoking treatment.