We will investigate the effectiveness of an early (three-week post MI), focused nurse-conducted smoking intervention to promote maintenance (and cessation if necessary) in postmyocardial infarction (MI) patients.
The specific aims are to (1) develop and evaluated a nurse-conducted smoking intervention for post-myocardial infarction patients (2) to determine if self-efficacy can be used to identify patients experiencing difficulty in maintaining cessation and to provide effective interventions for subjects exhibiting signs of relapse (3) to determine psychosocial and medical predictors of relapse (4) to determine smoking patterns that might identify populations at risk to develop subsequent cardiac events postMI. One hundred and sixty male postMI patients, ages 35-70, who have smoked within six months before the MI will be randomized into (a) nurse counseling smoking intervention or (b) no treatment control. All patients will be part of the Kaiser Permanente Health Care System. The subjects in the nurse counseling intervention will meet with the nurse for 30 minutes at a three week visit to the Stanford Cardiac Rehabilitation Center or at one of the Kaiser hospitals where they will be counseled as to the need to maintain nonsmoking (or stop smoking if they are still smoking), and will be given a smoking cessation manual, with an accompanying tape, and biweekly smoking self-efficacy forms that will help subjects target high-risk smoking situations and identify changes in confidence that might predict return to smoking. The nurse will contact each patient at 2,4,8,12,16,24-week post MI to determine if they are still smoking. Patients who begin smoking during the first year postMI will be given an intensive cessation program which will include nicorette gum and weekly counseling (up to four sessions) until cessation occurs. At three weeks all subjects will undergo a battery of psychological tests to identify possible predictors of smoking. In addition at 3, 26 and 52 weeks post-MI, all subjects will provide a serum thiocyanate and a CO, and smoking survey. The goal of the intervention will be to produce a 25% or greater smoking cessation than in the control group at six months. If successful the research will develop and demonstrate the effectiveness of an inexpensive program to produce significantly greater cigarette cessation maintenaace in post-Myocardial infarction patients than occurs under conditions of usual care.
