There are over 13 million smokers ages 50+ in the United States, who tend to be heavy, long-term smokers who are more likely to have chronic diseases caused or exacerbated by smoking. Stopping smoking can reduce morbidity and mortality from disabling diseases and conditions across the lifespan. Thus, the implications of smoking and smoking cessation for maintenance of health and independent living for older populations are considerable. Little data are available on effective treatments for smoking in this growing population. Assisted self-help interventions seem particularly appropriate to this group, who may be limited geographically or by health status in their ability to access smoking intervention services. Preliminary results from the current and preceding trials suggest that proactive telecounseling, in combination with a self-help manual and access to a reactive quitline, enhances quit rates, particularly among those using concurrent pharmacotherapy for smoking cessation. Results of other trials indicate that multiple quit attempts are often necessary to achieve smoking abstinence, and telecounseling may enhance recycling (i.e., re-quitting after a failed attempt). The proposed study will extend the scope of the current trial to examine the effectiveness of recycling smokers ages 50+ with a failed quit attempt in the past two years (recruited from the current trial and supplemented with community recruits). Two groups will be compared: 1) Minimal Intervention Control - self-help manual and access to a reactive quitline (smokers call in to the quitline for assistance); and 2) Proactive - manual and quitline along with proactive telecounseling calls (calls out to participants) to supporting re-quitting and supporting use of FDA approved pharmacotherapies for smoking cessation (nicotine replacement, bupropion, and others if they are approved during the period of study. Subjects will be followed at 6, 12, and 18 months for assessment of smoking status, health outcomes, and use of cessation resources (manual, quitline, proactive telecounseling, pharmacotherapy)
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