Principal investigator: Anne Joseph, MD

The specific aim 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) in order to determine if LC improves prolonged smoking abstinence. Smokers who are interested in quitting will be enrolled and randomly assigned to one of the two groups. Both groups will initially receive a state-of-the-science smoking cessation intervention including behavioral and pharmacological treatment, delivered by a combination of in-person and telephone care. Participants who fail to quit or relapse in the LC arm will receive systematic and intensive treatment over the ensuing 12 months that encourages periodic quit attempts and smoking reduction if they are not successful at quitting. We propose to include reduction as an intermediate goal in LC for those smokers who are not immediately ready to make another quit attempt because many smokers who try to stop but relapse do not initially resume former levels of smoking, especially while using pharmacotherapy.

This study is an efficacy trial to compare long-term smoking cessation rates in smokers receiving two different abstinence oriented strategies: longitudinal care (LC) (including smoking reduction) for nicotine dependence and discrete episodes of care (DC) including intermittent, occasional advice to quit. All participants will receive the same initial smoking cessation treatment course. Participants randomized to LC who relapse will be encouraged to use smoking reduction as a means to remain engaged in the quitting process and improve self-efficacy, until they are ready to make another quit attempt. Participants in the DC group will receive intermittent brief prompts to quit. Behavioral treatment for cessation and reduction will be delivered through a combination of initial in-person visits and telephone follow-up. Medication strategies during quit attempts and smoking reduction will be based on a set of principles (e.g. alleviating symptoms of nicotine withdrawal, past experience with medications, and smokers’ preferences) that mimic clinical practice, rather than a specific algorithm.