Over 13 million are smokers aged 50+ in the United States, and tend to be heavy, long-term smokers who are more likely to have chronic diseases cause or exacerbated by smoking. Older smokers also are overrepresented in rural areas. Stopping smoking can reduce morbidity and mortality from disabling diseases and conditions across the life span. Thus, the implications of smoking and smoking cessation for maintenance of health and independent living for older and rural populations are considerable. Recent emphasis on self-help, and particularly telephone-assisted, interventions seem especially appropriate to older urban and rural smokers who may have both physical and geographic limitations that reduce their access to services. The proposed study will examine the effectiveness of two such interventions relative to a control condition for mid-life and older rural vs. urban smokers. Subjects will be 1800 smokers aged 50+ recruited from an 11 county area and randomized to one of three interventions: 1) """"""""Letters"""""""" - self-help manuals + mailed prompts to call a reactive smokers' hot line (subjects call in to the hot line); 2) """"""""Proactive"""""""" - self-help manual + proactive telecounseling calls (counselors call out to subjects); 3) Control - self-help manual alone. The manual is targeted to smokers aged 50+, and the reactive hot line is available to all subjects, although only Letters and Proactive subjects will receive cues to call. Subjects will be followed by telephone at 6, 12, and 18 months for determination of smoking status and other smoking/health variables. Outcomes will include the clinical and cost effectiveness of these interventions by gender, across rural and urban areas, and across age groupings. In addition, the project will examine processes of change, and changes in health status for continuing smokers vs. quitters.
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