This is a proposal for a randomized clinical trial of five different physician antismoking interventions, all of which are designed to fit readily into the context of outpatient medical practice. Participants will be 2000 new adult patients being seen for the first time by their study physician. The study physicians will be residents in clinical training in the Departments of General Medicine and Family and Community Medicine who are seeing patients in four medical and family practice clinics associated with the Medical School. It is estimated that 75 residents will participate over the course of the study. A multifaceted training program has been developed which will fit conveniently into the regular residency training procedures. All residents will be trained to provide all five of the different interventions, and specific protocols will be used to guide residents in the appropriate treatment of individual patients according to the condition to which that patient is randomly assigned. The basic experimental design is a 2 x 2 design with two different intensities of physician intervention and two different intensities of therapeutic followup; the fifth experimental condition results from adding nicotine chewing gum to the maximal intervention/maximal folloup condition. There will be 400 patients in each of the five conditions. All will be followed for two years via phone contacts at months 3, 6, 12, 18 and 24 post-intervention. All patients reporting smoking abstinence at 3, 12 or 24 months will be seen in person for collection of a salivary sample for cotinine analysis for objective determination of smoking status. Extensive psychosocial data will be collected to be used in assessing patient characteristics and experiences associated with successful versus unsuccessful smoking outcomes.
