In the cigarette smoking intervention literature, one of the most widely adopted and disseminated interventions are telephone tobacco quit lines (QLs).While QLs are efficacious, cessation rates are modest and relapse is marked. To date, no studies have evaluated methods of re-engaging smokers who call QLs that either fail to quit smoking or relapse. Our survey of QLs serving all 50 states revealed that QLs encourage one of two methods for reengagement for those that have relapsed or who failed to quit on their target quit date: (1) Re- initiate the entire QL intervention (Recycle);or (2) reduce the number of cigarettes per day (i.e., Rate Reduction) with the ultimate goal of quitting. Despite widespread use of these reengagement interventions, no empirical evidence exists supporting either these treatment reengagement strategies in tobacco QLs. The focus of this application is to extend our research with our validated tobacco QL in the military. Our rationale includes the fact that military personnel have among the highest rates of cigarette use in the U.S. Active duty military personnel are at high risk for smoking, but represent an underserved population. Smoking rates among active duty personnel range from 26% to 40%, depending on the service branch. Unique challenges to reducing tobacco use in the military exist, including high personnel mobility, remote locations, and limited healthcare service access. Many efficacious stop-smoking programs in civilian populations do not demonstrate efficacy when evaluated in a military population. In our previous funding period, we have documented that our military-tailored QL was associated with extremely high rates of sustained smoking cessation. Our military proactive QL produced superior cessation rates at a one year follow-up compared to a reactive QL. But similar to civilian QLs, we observed marked decay of sustained cessation rates from the end of treatment to the one year follow-up. An opportunity exists to reengage smokers who relapse or fail to quit by the end of QL treatment. As mentioned above, civilian QLs use Recycling and Rate Reduction as the primary method for treatment reengagement. Unfortunately these methods of reengaging the relapsed/failed to quit smoker have not been systematically evaluated. As such, we propose to randomize participants who relapse or fail to quit by the end of the intervention to either (1) repeating the proactive QL (Recycle);(2) smoking reduction with the goal of eventual cessation (Rate Reduction);or (3) the choice of Recycle or Rate Reduction (Choice). Efficacy will be established by assessing both point prevalence and continuous abstinence at a 12 month follow-up. While QL targeted to the military for ultimate dissemination is needed, our findings should be nonetheless generalizable to all tobacco QLs.
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