Cigarette smoking is the single most alterable risk factor for the prevention of morbidity and mortality from coronary artery disease (CAD) in the United States. Several epidemiologic studies have also demonstrated that among patients who already have clinical CAD the risk of subsequent coronary events and mortality is lower among those who stop smoking relative to those who stop smoking relative with coronary hert disease, however, has varied from 22% to 78% studies using differing follow-up points and intervention techniques. Given this background, a randomized controlled trial is proposed to examine differences in long-term cessation rates among patients undergoing cardiac catheterization at the University of Massachusetts Medical Center (UMMC) who are found to have significant CAD. The catherization laboratory population has been selected because the degree of CAD and concomitant functional impariment is well defined in these patients. Approximately 360 patients satisfying predetermined eligibility criteria will be randomly assigned over an eighteen month recruitment period to one of two intervention protocols: an advice only (AO) and a special intervention (SI) group. Patients randomly allocated to the AO group will receive an anti-smoking message, while those in the SI group will receive, in addition to the intervention provided to AO participants, an in-hospital smoking cessation counseling session and subsequent enrollment in a six session broad-spectrum outpatient smoking cessation program. Follow-up of study subjects will be conducted at 6, 12, 18, and 24 months based on time of patient entry. Validator of self-reported abstinence from smoking at 12 and 24 months will be carried out using salivary continue determinations. Differences in smoking cessation rates and other trial endpoints will be determined at these follow-up points. This study will continue to a greater understanding of those factors and intervention approaches that assist patients with CAD to stop smoking. Techniques developed in this project would be applicable to modification of other risk factors with behavioral components, such as hypertension and hyperlipidemia.
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