The purpose of this grant is to discover the most important attitudes and beliefs (i.e., internal barriers) that prevent smokers from seeking treatment; e.g., beliefs that seeking treatment is a sign of weakness or that treatments do not work. Such knowledge could be used to devise media and other interventions to increase treatment seeking among smokers. Several behavioral and pharmacological treatments for smoking cessation have been well validated; however, even when external barriers such as awareness, cost and availability are minimized, few smokers trying to quit access treatment. We hypothesize certain beliefs and attitudes of smokers are internal barriers to seeking treatment. Studies have examined internal barriers to attempting to quit smoking and to succeeding in quitting smoking; however, few have examined internal barriers to seeking treatment per se. We will focus on the use of telephone help line treatments as this is the most commonly used psychosocial treatment for smoking cessation and is free of most external barriers; e.g., high cost and low availability. Study 3 is our main validity test of whether internal barriers are important. Studies 1A and 1B will generate a list of possible internal barriers to use in Study 3. Study 1A will interview 16 smoking cessation/drug dependence experts on why smokers/drug abusers do not seek treatment even when external barriers are minimized. Study 1B will ask 80 smokers who have recently tried to stop smoking and were aware of an available phone quit line to volunteer reasons they did or did not use this treatment. Study 2 will select barriers to be used in Study 3. We will administer barrier items from Studies 1A and 1B to 400 recent quit attempters to examine understandability and response bias. We will conduct an exploratory factor analysis in 200 of these smokers to derive a set of factors that covers the breadth of internal barriers followed by a confirmatory factor analysis in the other 200 smokers. We will also conduct tests of test-retest reliability, content validity, concurrent validity and discriminant validity. Study 3 will be a test of predictive validity; i.e. a test of whether our internal barrier factors prospectively predict use of a help line. We will recruit 560 smokers who plan to quit in the next 30 days, inform them of a free phone help line and ask them our barrier items. They will be re-contacted 2 months later to determine which of our internal barrier factors best predict calling the help line. To assess generalizability, we will also determine if our factors also predict use of other smoking cessation treatments. Our results will suggest messages for media campaigns and for clinicians to use to motivate smokers to access proven treatments.
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