The primary aim of the proposed research is to evaluate the use of telephone counseling as an adjunct to a minimal smoking cessation intervention as a way to enhance (a) the maintenance of abstinence and (b) the rates of recycling following a relapse. Relapse following smoking cessation continues to be a significant problem. The majority of relapse takes place within three months of cessation, but ex-smokers are still at high risk for relapse for at least two years following cessation. Clearly, efforts at maintaining abstinence must remain a high priority for cessation programs, as should efforts at encouraging recycling (achieving a subsequent period of abstinence following a failed attempt to quit). The present study proposes to develop a maintenance and recycling intervention, targeted to women with a high school education or less, which uses continued phone contact following a televised cessation intervention. The design comprises two conditions: (a) Maintenance and Recycling Intervention (N = 900) and (b) No Contact control (N = 900). Only subjects who have achieved at least a 48-hour abstinence period with the televised cessation program will be entered into this study. Subjects in the Intervention condition will receive six telephone calls from a counselor over a three to four month period and a seventh telephone call approximately nine months later, just prior to the Great American Smoke-Out. The primary goals of the telephone calls are (a) to provide support and encouragement, (b) to help identify barriers hindering maintenance or recycling, and (c) to set goals for maintenance or recycling. We hypothesize that the Maintenance and Recycling Intervention, as compared with the No Contact Control, will increase both the number of subjects who maintain abstinence throughout the follow-up period and the number of subjects who recycle following a relapse. Follow-up data will be collected every six months through a 36- month follow-up. In addition, in the year after the Maintenance and Recycling Intervention (Phase 1), we will evaluate the effectiveness of institutionalizing the telephone counseling intervention (Phase 2) by using volunteers from the American Cancer Society (ACS) as telephone counselors and tying their efforts to the Great American Smoke-Out. The results of the intervention using ACS volunteers will be compared with those obtained in the Phase 1 intervention with trained, paid counselors. In addition to the experimental evaluation of the intervention, we will examine the roles of several psychosocial variables (i.e., self-efficacy, negative affect, motivation, and social support) in the maintenance and recycling processes, with a specific emphasis on examining the role of social influence processes. Finally, by collecting more frequent data on daily smoking and quitting behavior, we will describe and define longitudinal patterns of change following cessation.
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