The proposed research continues work on translating theory and research on intrinsic and extrinsic motivation into the area of addictive behavior change. Based upon promising preliminary results of our urrent research (NICA project #801 DA04447-02, """"""""Increasing Use of Self-Help Relapse Prevention Programs"""""""") we propose to: (1) examine a conceptual model of motivation and staged behavior change in a population sample of smokers; (2) assess the impact of a self-help program for smoking cessation and relapse prevention in a reprosentative sample of smokers (i.e., not self-selected) from a defined HMO population; (3) compare the impact of intrinsic and exthnsic motivation enhancemeryt strategies on program use, lnftial and long-term smoking cessation; and (4) evaluate whether stage of cessation and type of motivation modify the effects of the interventions. The specffic research questions that this investigation will address are: (1) What is the relation between stage of cessation and types of motivation for quitting smoking; (2) What is the impact of a self-help program distributed to a random sample (i.e., not self-selected) of smokers in a defined population; (3) What is the impact on self-help prograr'. utilization and smoking cessation of intrinsic and extrinsic motivation enhancement strategies in a random sample of smokers in a defined population; (4) How do stage of change and type of motivation modffy the effects of the self-help program and motivation strategies? The proposed study is a population-based randomized controlled clinical trial involving: (1) Identification of a random sample of 7200 adult enrollees in Group Health Cooperative of Puget Sound, with an expected 27% smoking prevalence; (2) A telephone survey in this sample in order to identify 1600 smokers and assess their stage of change; (3) Randomization of smokers to: (a) a self-help cessation program wfth an intrinsic motivation strategy (n = 400), an extrinsic mottvation strategy (n = 400) or no motivation strategy (n = 400); or (b) a no-treatment control cond ition (n = 400). The intrinsic motivation strategy will consist of personalized feedback and the exthnsic motivation strategy will be a financ!W incentive; (4) At 3 and 12 months post-randomization, obtain data on stage of cessation, initial cessation and fong-term abstinence from all smokers, plus data on program utilization from the smokers who received the self-help program. Reported abstinence at 12 months will be biochemically validated wfth saliva cotinine analysis. The long-term objective of this project is to provide effective strategies for enhancing use of self-help materials that are applicable in large scale public health prevention programs.
