Cigarette smoking is now labelled as the single most important environmental factor contributing to premature mortality in the United States. Over 60% of smokers have tried to quit and almost 30% attempt to quit every year. Very few are willing to enroll in formal cessation programs, but smokers attempting to quit list physician support as important and authoritative. An estimated 80% wil see a physician within a two-year period, but physicians rarely perform effective smoking cessation activities. Reasonably effective minimum intervention smoking cessation programs are available and if a program could be developed that recruited physicians to deliver a smoking cessation program, physicians might make a significant impact on smoking cessation rates. This project will develop 1) a physician recruitment program in conjunction with 2) a two day physician training workshop that will teach physicians to integrate an in-office smoking cessation campaign into their practice routines. To develop the recruitmen program, physicians will be interviewed and surveyed to identify factors which promote or inhibit their smoking cessation activities. These will be used to develop a more attractive and compelling program to recruit physicians to the training workshop. To test whether the recruitment program is successful, a random sample of physicians will be mailed a 'standard' brochure for the workshop and a random sample will receive the 'improved' recruitment program that is based on the physician interviews. It is hypothesized that the 'improved' materials will result in a doubling of physician response. The training workshop will teach physicians to deliver a brief and succinct smoking cessation message centered around a self-help program, Quit-and-Win, which has shown encouraging effectiveness. The physicians will also be taught the correct use of nicotin chewing gum. To evaluate the training workshop, practices will be randomly allocated to one of three groups: 1) A control group asked only to conduct a smoking-cessation campaign, 2) a materials group given unlimited access to Quit-and-Win and instructions for using nicotine chewing gum, and 3) a training group given the workshop, unlimited acess to Quit-and-Win, and instructions for using nicotine chewing gum. It is hypothesized that the workshop will result in significantly higher smoking cessation rates vis-a-vis either educational materials alone or no intervention. Smoking cessation will be evaluated with serum cotinine analysis at one and two years after the intervention.
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