Older Americans, especially those aged 50-74 years, can achieve significant health benefits from stopping smoking. Yet, in the past, smoking cessation programs have not been directed at older smokers. Moreover, there is recent evidence that, in the absence of a smoking-related illness, physicians do not routinely offer a strong cessation message to older smokers. In this research, we will (1) identify the extent of and correlates of smoking and cessation of older adults (Phase I), (2) test the efficacy of two cost-efficacy of two cost-effective strategies, mailed and telephone reinforcements, for promoting adherence to a self-help quitting regimen among older adults accrued through community and worksite settings (Phase II) and finally, (3) assess the impact of the most effective regimen in combination with a strong physician cessation message (Phase III) from primary physicians practicing in an IPA-model HMO. The evaluation is based on randomized research designs that will permit an assessment of the impact of more intensive interventions for both phases on quitting behavior and the health status correlates of cessation. Data will be collected through self-administered questionnaires at baseline and telephone follow-ups at 3, 6, 12 and 24 months for Phase II and 6, 12 and 18 months for Phase III with the most important outcome being self-reported quitting status. We will obtain measures of process, impact and outcome. Biochemical verification will be obtained on a sample of self-reports. Clear Horizons will contribute to the Year 2000 goals by developing tailored interventions that are designed to reduce smoking among high-risk, long-term smokers aged 50-74 years of age. Our study collaborators include Mathematica Policy Research (MPR), US Healthcare, the American Lung Association (ALA), ACORN (a large employee assistance program) and the American Association of Retired Persons (AARP).
