The overall goal of this project is to continue development and evaluation of a self-help behavioral smoking reduction program for chronic smokers. The program, LifeSign for Smoking Reduction (LS-SR), is targeted to chronic smokers who are unwilling to quit smoking, and for whom a reduction in smoking is a reasonable short-term goal. In Phase I, we developed a prototype of the LS-SR program that used scheduled gradual reduction principles to reduce smoking by 50 percent and maintain these reductions, successfully recruited 99 smokers appropriate for a smoking reduction intervention, and assessed the feasibility of this prototype in a randomized controlled trial comparing LS-SR to a manually-guided research trial. The LS-SR condition produced greater, frequently significantly greater reductions, in various measures of smoking behavior, dependence, and nicotine exposure. For Phase II, we propose to modify the LS-SR program based on the Phase I results and compare this programs to a manually-based smoking reduction condition in 375 smokers who are not amenable to quitting smoking. Subjects will be randomly assigned to one of these self-help interventions and will be assessed at pre-intervention, at post-intervention 7 weeks later and at 14 and 28 weeks post-interventions. The primary outcome measure for the study will be 7 day reconstruction of daily smoking rate corroborated by CO and saliva cotinine assessment. CO and measures of short-term changes in health status (e.g. BP, and exertion, health status questionnaire.) Physical fitness will be measured at all assessment points. To determine the effect of smoking reduction on subsequent quit attempts, reported quit attempts, methods of quitting, and periods of abstinence (biochemically validated) as well as self-efficacy to quit and Stages of Change will be assessed at all visits. Additionally, measures of smoking typography will be obtained to measure directly the degree of compensatory smoking resulting from reduced smoking.
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