Despite many years of education, social pressure, physician advice and effective treatments, the average smoker tries to quit only once every three years; thus, interventions to prompt smoking cessation are needed. This application tests whether a behavioral instruction program plus nicotine gum will induce a large and durable reduction in smoking and whether this will serve as a success experience and thereby prompt a quit attempt. Smokers who do not plan to quit smoking in the next month will be randomly assigned to one of four groups: non-specific therapy + brief advice to quit, a behavioral instructional program to reduce smoking + brief advice to quit, behavioral instructions to reduce + advice + placebo gum, or behavioral instructions to reduce + advice + nicotine gum. To increase generalizability, treatment will be delivered via written materials and five telephone contacts. Our major hypothesis is that both behavioral instructions to reduce and nicotine gum will each increase quit attempts over the ensuing 12 months. We will also test whether increased self-efficacy or the magnitude and duration of reduced smoking mediate any increase in quit attempts. Finally, we will monitor the safety of concurrent use of gum and cigarettes. The present application is not designed to test reduced smoking as a treatment for cessation among smokers trying to quit (i.e., """"""""gradual reduction""""""""). It also is not a test of reduced smoking as a goal in itself (i.e., """"""""harm reduction""""""""). Rather, the application focuses on using reduced smoking to prompt cessation. Current public health strategies discourage reduced smoking. If we show reduced smoking prompts quit attempts, it will suggest reconsideration of reduced smoking as an intermediary step toward quitting smoking.
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