The overall aim of the proposed research is to continue to study the process of recycling failed smoking cessation attempts and relapses. We will focus on two subsets of smokers frequently ignored by researchers and intervention programs: subjects who fail to quit with a cessation program and subjects who relapse after achieving abstinence. Depending on the type of treatment, between 25% and 80% of smokers fail to quit with a program (Schwartz, 1987; USDHHS, 1991), and of those who initially quit, as many as 80% may relapse within a year (USDHHS, 1991). Thus, we need to understand more about the consequences of these """"""""failures"""""""" on subsequent cessation attempts and success and to develop more effective treatment programs to recycle these smokers into sustained abstinence. Our primary aim is to develop and evaluate the efficacy of an intervention tailored to stage of change (still smoking, abstinent, relapsed) that uses extended contact, motivation, and efficacy building strategies to: 1) increase the percentage of subjects who achieve subsequent abstinence after failing to quit with a core group treatment; 2) decrease relapse rates; and 3) increase the rate of sustained recycling (i.e., maintained abstinence) following a relapse. We will also test the extent to which the effects on abstinence are explained by the mediating variables of motivation and self- efficacy. Secondary aims include: 1) examining the role of several psychosocial variables in the maintenance, relapse, and cessation processes; 2) describing and examining longitudinal changes following smoking cessation; and 3) examining the long-term (beyond two years) effects of the current study's intervention. The design of the proposed study comprises two conditions: 1) Control Condition (N = 427) and 2) Enhanced Treatment Condition (N = 427). the two treatment conditions will have a common core 7-week cessation and relapse prevention group program. Following the group program, the two conditions will differ in both format and content of treatment. Subjects in the Control Condition will receive 7 counselor-initiated phone calls over a 3 month period. The content of the phone calls will represent the most effective components of the present study and will vary depending on whether the subjects are smoking or abstinent. Treatment in the Enhanced Condition will be tailored to three groups of subjects: smokers, abstainers, and relapsers. Subjects who are smoking at the end of the core program will receive three more weekly group meetings followed by 3 phone calls, and then 6 monthly calls. The content of their treatment will be based on the factors that our current study found most related to failure to quit (negative affect, low motivation, low efficacy). Subjects who are abstinent at the end of the core program will receive 7 phone cells over a three month period and then 6 monthly calls. The content of their treatment will include efficacy and motivation building exercises as well as the continued contact for six more months than in the Control condition. Follow-up data will be collected every 3 months for 15 months beyond the core cessation program. We hypothesize that the Enhanced Treatment, compared with the Control, will improve rates of recycling after a failure to quit, decrease relapse rates, and increase sustained recycling following a relapse.
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