The proposed research is designed to develop and evaluate efficacious and cost-effective combinations of behavioral interventions and Nicotine Replacement Therapy (NRT) for smoking cessation. NRT has been demonstrated to be effective but has been used by only a small percentage of the smokers. In contrast, population based interventions with proactive recruitment and stage matched interventions have the potential to reach more than 80 percent of the population. The proposed research will combine NRT with two recently developed, highly effective behavioral interventions that employ digital technology to produce individualized, low cost interventions. These interventions have the potential to both increase the proportion of smokers who receive NRT and the effectiveness or NRT. Expert System interventions based on the Transtheoretical Model have demonstrated effectiveness in two population-based studies without NRT. Telecommunications represents a low cost method of providing high frequency always available automated counseling services to smokers. The proposed study is a population based clinical trial with 2200 smokers proactively recruited from a large VA system and randomly assigned to one of four conditions, varying from minimal intervention to high intensity. The conditions include: (1) Minimal Intervention, which involves only stage-matched manuals; (2) NRT Alone, which provides NRT with only manuals; (3) Expert System, which combines NRT, the Expert System and Manuals; and (4) Telecommunications, which combines the previous interventions with an automated telephone counseling intervention. In the three NRT conditions, NRT will be provided only to those smokers for whom it is appropriate. A goal of the behavioral interventions is to increase the proportion of the smokers who receive NRT. Data analysis will identify the most efficacious interventions in preparation for dissemination to entire population. Stage matched, interactive, and proactive interventions that match behavioral and pharmacological elements to the individual smoker have the potential to produce unprecedented impacts on an entire population of smokers.
