The proposed study will evaluate the efficacy and cost-effectiveness of a theoretically- and empirically-based 'Motivation And Problem Solving' (MAPS) intervention for promoting and facilitating smoking cessationamong low income smokers who are not ready to quit. Approximately 90% of current smokers (over 41 millionpeople) are not ready to quit smoking at any one point in time. MAPS is a holistic, dynamic approach tofacilitating behavior change that utilizes a combined motivational enhancement and social cognitive approachbased on motivational interviewing (MI) the Treating Tobacco Use and Dependence Clinical PracticeGuideline, and social cognitive theory. MAPS is designed for all smokers regardless of their readiness to quitor phase of the quitting process, and specifically targets motivation and intrinsic motives for change, socialcognitive constructs (e.g., agency/self-efficacy), and other key factors of particular relevance to low incomesmokers (e.g., stressors, family issues, financial resources). Because MAPS encompasses a chronic care typeapproach to treating tobacco use and revolves around a 'wellness program' that addresses numerous barriersand concerns that are prevalent among low income individuals, we believe it is particularly appropriate fortreating such smokers. Participants (N = 900) will be cigarette smokers attending community health clinics operated by the HarrisCounty Hospital District (HCHD). HCHD is the safety net public health care system serving Houston and HarrisCounty, the nation's fourth largest city and third most populous county. HCHD serves only the uninsured andunderinsured. All participants will be followed for a period of two years, and will be randomly assigned to one ofthree groups: 1) Standard Treatment [ST], 2) MAPS-4, or 3) MAPS-8. ST will consist of a letter referringsmokers to Texas Quitline, and standard self-help materials. ST will occur a total of 4 times (Baseline, 6, 12,and 18 months). MAPS-4 will consist of ST plus 4 proactive MAPS telephone counseling sessions over a 2-year period. MAPS-8 will consist of ST plus 8 proactive telephone counseling sessions over a 2-year period.Assessments will occur at Baseline and at 6, 12, 18, and 24 months after Baseline. The primary outcomevariables are abstinence from tobacco across the 6, 12, 18, and 24-month follow-ups, and at the 24-monthfollow-up. Secondary outcomes will include quit attempts and use of the Texas Quitline.
The proposed study will evaluate the efficacy and cost-effectiveness of a theoretically-and empirically-based ''Motivation And Problem Solving'' (MAPS) intervention forpromoting and facilitating smoking cessation among low income smokers who are notready to quit. Approximately 90% of current smokers (over 41 million people) are notready to quit smoking at any one point in time.
