This project will examine the feasibility of reducing cigarette smoking among cardiac patients. In addition, it will examine factors associated with successful smoking cessation and tobacco abstinence and factors associated with failure to stop smoking and with relapse to smoking. The study is a prespective randomized clinical intervention trial which will follow patients for at least one year to assess smoking status outcomes and to assess morbidity and mortality outcomes. Smoking status will be confirmed by biological indices. Approximately 500 - 600 cardiac patients who are cigarette smokers at the time of intake will be randomized among Usual Care and Special Care conditions. the Special Care intervention will be multifactorial -- consisting of directive health advice, feedback of breath carbon monoxide levels, multicomponent risk-reduction counseling and eduction, and intensive efforts to engage family social support/encouragement for smoking cessation and risk reduction. Intervention will take advantage of the presumed receptiveness/vulnerability of patients to health advice at the time of in-hospital cardiac examinations or treatment. Patients will be recruited from three sites -- myocardial infarction and angina patients hospitalized in the acute Coronary Care Unit, patients referred for exercise stress test evaluation who have differing diagnostic outcomes, and patients who are referred for cardiac catheterization who have differing diagnostic and treatment recommendation outcomes. Analyses will assess (1) the efficacy of the overall smoking risk reduction intervention program; (2) the role of cardiac functional or diagnostic status as a predictor of smoking cessation; (3) the comparative efficacy of different clinical settings for smoking cessation recruitment and intervention; (4) the role of patient social support/familial involvement in sustaining smoking cessation; (5) factors associated with smoking relapse in cardiac patients.
