Cigarette smoking is the number one preventable cause of morbidity and mortality in this nation 8, 9. Preventing relapse is a high priority for those attempting to quit smoking as most people who attempt cessation relapse within a very short period of time 10. Of smokers who receive a formal cessation program, at least 70 percent relapse 10; among self-quitters, the relapse rate is approximately 90 percent 11. It is the case, however, that the vast majority of smokers who try to stop smoking do so with no or with minimal assistance 12. Population-based approaches such as tobacco quit lines and internet interventions are becoming increasingly more prevalent 13-15 16 as the field moves directly towards an emphasis on dissemination. While the vast majority of smokers try to quit on their own, surprisingly little research has been conducted on reducing relapse among self-quitters. Brandon and colleagues 6, 17 7 have demonstrated that a series of 8 printed self-help booklets consistently produced higher point-prevalence abstinence rates in smokers that had quit on their own. Given the enormous public health implications of this approach, more research on promoting long-term self-quitting is clearly needed. Virtually all research to date on promoting self-quitting has been conducted in samples where participants have voluntarily stopped smoking prior to participating in the interventions 6, 7. However, nothing is known about methods of preventing relapse following involuntary abstinence (e.g., military training, during hospital stays, in jails, prisons, & psychiatric facilities). Previous research 1, 2 has determined that protracted involuntary cessation in the military with no other intervention is associated with significant long-term cessation rates (15- 20 percent at a one-year follow-up). Since, to our knowledge, no study has successfully intervened to reduce relapse rates following a protracted involuntary abstinence, our specific aims are as follows: (1) To recruit approximately 5200 United States Air Force (USAF) recruits at the end of Basic Military Training (BMT) who were regular smokers prior to an 8-week involuntary cessation during BMT; (2) To randomize participants either to (a) standard forced cessation, (b) forced cessation + printed materials (proven to be efficacious in previous studies among those who voluntarily quit on their own), (c) forced cessation + 3 proactive relapse prevention telephone calls, or (d) forced cessation + printed materials + 3 proactive relapse prevention telephone calls, in a 2 x 2 factorial design (printed materials yes vs. no crossed with proactive telephone treatment, yes vs. no). (3) To determine the long-term (12 month) efficacy of the cessation maintenance intervention. Our primary outcome is smoking cessation maintenance at the 12 month follow-up. The secondary outcome is smoking cessation maintenance at the 6 month follow-up.
Despite large campaigns, over 22 percent of adult Americans smoke. The vast majority of people try to quit smoking on their own but most fail at these attempts. The current study will test ways of helping people who have quit involuntarily to maintain their abstinence. Since smoking is the #1 cause of premature mortality and morbidity in this country, the public health significance of this project is high.
